Provider Demographics
NPI:1043391212
Name:HOLMAN, CLARENCE T III (L AC)
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:T
Last Name:HOLMAN
Suffix:III
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:704 COTTAGE ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2410
Mailing Address - Country:US
Mailing Address - Phone:503-881-8361
Mailing Address - Fax:503-316-5110
Practice Address - Street 1:704 COTTAGE ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2410
Practice Address - Country:US
Practice Address - Phone:503-881-8361
Practice Address - Fax:503-316-5110
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORAC00569171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist