Healthcare Provider Details

I. General information

NPI: 1922096155
Provider Name (Legal Business Name): PAUL RICHARD HORST D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S 2ND ST
MAQUOKETA IA
52060-2948
US

IV. Provider business mailing address

123 S 2ND ST
MAQUOKETA IA
52060-2948
US

V. Phone/Fax

Practice location:
  • Phone: 563-652-3191
  • Fax: 563-652-7008
Mailing address:
  • Phone: 563-652-3191
  • Fax: 563-652-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA5330
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: