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General NPI Number Information
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NPI Number | 1730628041
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Entity Type | Organization
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Legal Business Name | CORNERSTONE CHIROPRACTIC OF HORTONVILLE LLC
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 05/07/2018
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Provider Practice Location Address
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Address Line | 223 N PINE ST
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City | HORTONVILLE
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State | WI
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Zip | 54944-9140
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Country | US
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Telephone | 920-850-2507
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 187
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City | HORTONVILLE
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State | WI
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Zip | 54944-0187
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JARED SCOTT BEDOR
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Credential | DC
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Telephone | 920-850-2507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5233-12
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License Number State | WI
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