Provider Demographics
NPI:1801800628
Name:HORTON, JOHN EVERETT (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EVERETT
Last Name:HORTON
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 1:108 WIKIUP DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSE
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1338
Mailing Address - Country:US
Mailing Address - Phone:707-528-2225
Mailing Address - Fax:707-528-1388
Practice Address - Street 1:108 WIKIUP DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSE
Practice Address - State:CA
Practice Address - Zip Code:95403-1338
Practice Address - Country:US
Practice Address - Phone:707-528-2225
Practice Address - Fax:707-528-1388
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U37979Medicare UPIN
DC0202300Medicare ID - Type Unspecified