Individual
JOHN HENRY EIDEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
514 E LAKE ST, HORICON, WI 53032-1247
(920) 485-4009
(920) 485-0632
Mailing address
514 E LAKE ST, HORICON, WI 53032-1247
(920) 485-4009
(920) 485-0632
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2303012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38850600
—
WI
Enumeration date
12/07/2005
Last updated
07/29/2010
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