Provider Demographics
NPI:1033458567
Name:HOLBROOK, CHRISTOPHER E SR
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:E
Last Name:HOLBROOK
Suffix:SR
Gender:M
Credentials:
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 703
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-0703
Mailing Address - Country:US
Mailing Address - Phone:740-259-0808
Mailing Address - Fax:740-259-4095
Practice Address - Street 1:10324 US RTE 23
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648
Practice Address - Country:US
Practice Address - Phone:740-259-0808
Practice Address - Fax:740-259-4095
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMEL11495332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies