Provider Demographics
NPI:1023535150
Name:HOLST FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:HOLST FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-659-9935
Mailing Address - Street 1:704 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1325
Mailing Address - Country:US
Mailing Address - Phone:563-659-9935
Mailing Address - Fax:563-659-3243
Practice Address - Street 1:704 11TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1325
Practice Address - Country:US
Practice Address - Phone:563-659-9935
Practice Address - Fax:563-659-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty