Healthcare Provider Details

I. General information

NPI: 1578801585
Provider Name (Legal Business Name): BARNEVELD FAMILY CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S JONES ST
BARNEVELD WI
53507-9801
US

IV. Provider business mailing address

101 S JONES ST
BARNEVELD WI
53507-9801
US

V. Phone/Fax

Practice location:
  • Phone: 608-924-2424
  • Fax: 608-924-2425
Mailing address:
  • Phone: 608-924-2424
  • Fax: 608-924-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3813-12
License Number StateWI

VIII. Authorized Official

Name: DR. KIMBERLY ANN HORSFALL
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 608-924-2424