Healthcare Provider Details

I. General information

NPI: 1164097705
Provider Name (Legal Business Name): REALIGN FAMILY CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4877 LARSON BEACH RD
MCFARLAND WI
53558-8735
US

IV. Provider business mailing address

1817 CEDARBROOK LN UNIT 11
STOUGHTON WI
53589-5256
US

V. Phone/Fax

Practice location:
  • Phone: 608-921-8830
  • Fax:
Mailing address:
  • Phone: 608-921-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW M HOUFE
Title or Position: OWNER
Credential: DC
Phone: 608-921-8830