Provider Demographics
NPI:1033258413
Name:HOLT, BRIAN PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PATRICK
Last Name:HOLT
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 1:195 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1238
Mailing Address - Country:US
Mailing Address - Phone:845-623-0536
Mailing Address - Fax:845-623-7382
Practice Address - Street 1:300 N MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1262
Practice Address - Country:US
Practice Address - Phone:845-620-0939
Practice Address - Fax:845-620-0940
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX001932111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
X11772Medicare PIN
T51927Medicare UPIN