Provider Demographics
NPI:1700925062
Name:HORNE, DAVID R (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:HORNE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 SCALP AVENUE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3036
Mailing Address - Country:US
Mailing Address - Phone:814-266-6121
Mailing Address - Fax:814-262-0077
Practice Address - Street 1:1105 SCALP AVENUE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3036
Practice Address - Country:US
Practice Address - Phone:814-266-6121
Practice Address - Fax:814-262-0077
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002319L111N00000X
PAAJ002319L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008440450001Medicaid
PA0008440450001Medicaid
T30002Medicare UPIN