Healthcare Provider Details

I. General information

NPI: 1578520912
Provider Name (Legal Business Name): PETER J. HORN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W MAIN ST SUITE 101
CARPENTERSVILLE IL
60110-1788
US

IV. Provider business mailing address

5 BROM CT
SLEEPY HOLLOW IL
60118-3122
US

V. Phone/Fax

Practice location:
  • Phone: 847-428-1515
  • Fax: 847-428-0024
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38-004866
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: