Provider Demographics
NPI:1114422987
Name:HOLMAN, RAE LYNNE (DC)
Entity Type:Individual
Prefix:MS
First Name:RAE
Middle Name:LYNNE
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:RAE
Other - Middle Name:LYNNE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3552 SW MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-2327
Mailing Address - Country:US
Mailing Address - Phone:816-988-0058
Mailing Address - Fax:
Practice Address - Street 1:3552 SW MARKET ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-2327
Practice Address - Country:US
Practice Address - Phone:816-988-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05894111N00000X
MO2019006977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor