=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275964413
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HORSLEY ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2013
-----------------------------------------------------
Last Update Date | 12/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28253 DUPONT BLVD SUITE 1
-----------------------------------------------------
City | MILLSBORO
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19966-1223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-934-7350
-----------------------------------------------------
Fax | 302-934-7319
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28253 DUPONT BLVD SUITE 1
-----------------------------------------------------
City | MILLSBORO
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19966-1223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-934-7350
-----------------------------------------------------
Fax | 302-934-7319
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. RANDAL L. HORSLEY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 302-934-7350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 2013604635
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------