Healthcare Provider Details

I. General information

NPI: 1205838687
Provider Name (Legal Business Name): STEVEN WILLIAM HORAK D.C.,C.C.S.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WEST MAIN STREET
FREDERICKSBURG IA
50630
US

IV. Provider business mailing address

PO BOX 323
FREDERICKSBURG IA
50630-0323
US

V. Phone/Fax

Practice location:
  • Phone: 563-237-6560
  • Fax: 563-237-6562
Mailing address:
  • Phone: 563-237-6559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberA05724
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: