Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | A05724 | IA |
NPI | 1205838687 |
---|---|
Provider Name | Dr. Steven William Horak |
First Address | Fredericksburg, IA 50630-0323 |
Second Address | Fredericksburg, IA 50630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 03/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0106864 | (05) | IA |
U45536 | (02) |