Provider Demographics
NPI:1013040419
Name:HOLMAN, PAUL E (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 CASCADE AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1087
Mailing Address - Country:US
Mailing Address - Phone:509-493-2882
Mailing Address - Fax:
Practice Address - Street 1:1000 W STEUBEN ST
Practice Address - Street 2:
Practice Address - City:BINGEN
Practice Address - State:WA
Practice Address - Zip Code:98605
Practice Address - Country:US
Practice Address - Phone:509-493-2882
Practice Address - Fax:509-493-2882
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2992111N00000X
CA19485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB21025Medicare PIN