Provider Demographics
NPI:1023001294
Name:HOLT, REGINA S (DC)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:S
Last Name:HOLT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7365 CARNELIAN ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1158
Mailing Address - Country:US
Mailing Address - Phone:909-944-5054
Mailing Address - Fax:909-944-1404
Practice Address - Street 1:7365 CARNELIAN ST
Practice Address - Street 2:STE. 101
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1158
Practice Address - Country:US
Practice Address - Phone:909-944-5054
Practice Address - Fax:909-944-1404
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30015156OtherTAT
CAU16374Medicare UPIN
CADCO191520Medicare ID - Type Unspecified