Provider Demographics
NPI:1144315177
Name:HORLEBEIN, JOHN WILLIAM (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:HORLEBEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2430
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-2430
Mailing Address - Country:US
Mailing Address - Phone:509-683-2131
Mailing Address - Fax:855-353-6993
Practice Address - Street 1:532 E. WOODIN AVENUE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-8631
Practice Address - Country:US
Practice Address - Phone:509-679-1415
Practice Address - Fax:509-679-1415
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000694213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2141374Medicaid
WA7104128Medicaid
WAG8851326Medicare PIN
WAGAB19820Medicare PIN
WA4266020001Medicare NSC