MEDICARE: REALIGN FAMILY CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	111NP0017X	Pediatric Chiropractor
2	111NS0005X	Sports Physician Chiropractor
3	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1164097705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REALIGN FAMILY CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1817 CEDARBROOK LN UNIT 11
Second Line	:
City	:	STOUGHTON
State	:	WI
Zip	:	53589-5256
Country	:	US
Telephone Number	:	608-921-8830
Fax Number	:

Provider Business Practice Location Address
First Line	:	4877 LARSON BEACH RD
Second Line	:
City	:	MCFARLAND
State	:	WI
Zip	:	53558-8735
Country	:	US
Telephone Number	:	608-921-8830
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW M HOUFE
Credential	:	DC
Telephone Number	:	608-921-8830

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	05/25/2021

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