Healthcare Provider Details

I. General information

NPI: 1952199010
Provider Name (Legal Business Name): STEVEN EIDEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 E LAKE ST
HORICON WI
53032-1265
US

IV. Provider business mailing address

514 E LAKE ST
HORICON WI
53032-1265
US

V. Phone/Fax

Practice location:
  • Phone: 920-485-4009
  • Fax: 920-485-0632
Mailing address:
  • Phone: 920-485-4009
  • Fax: 920-485-0632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: STEVEN EIDEM
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 920-485-4009