MEDICARE: DR BEAU A HORNER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1073070371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR BEAU A HORNER LLC

Provider Business Mailing Address
First Line	:	10221 N 32ND ST STE G
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3849
Country	:	US
Telephone Number	:	480-470-0133
Fax Number	:	602-429-8368

Provider Business Practice Location Address
First Line	:	10221 N 32ND ST STE G
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3849
Country	:	US
Telephone Number	:	480-470-0133
Fax Number	:	602-429-8368

Authorized Official
Title or Position	:	OWNER
Name	:	BEAU A HORNER
Credential	:	DC
Telephone Number	:	480-470-0133

Provider Enumeration Date	:	02/23/2019
Last Update Date	:	11/11/2019

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Directions to “DR BEAU A HORNER LLC ” Practice Location

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