Healthcare Provider Details

I. General information

NPI: 1043321912
Provider Name (Legal Business Name): FAMILY CHIROPRACTORS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W MAIN ST
HORTONVILLE WI
54944-9413
US

IV. Provider business mailing address

PO BOX 100
HORTONVILLE WI
54944
US

V. Phone/Fax

Practice location:
  • Phone: 920-779-4554
  • Fax: 920-779-0444
Mailing address:
  • Phone: 920-779-4554
  • Fax: 920-779-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT DAVID SELL
Title or Position: PRESIDENT
Credential: DC
Phone: 920-779-4554