Provider Demographics
NPI:1174680672
Name:HOLTSCHLAG, MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:HOLTSCHLAG
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 1:2000 JEFFERSON
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-5655
Mailing Address - Country:US
Mailing Address - Phone:217-228-2040
Mailing Address - Fax:217-228-2042
Practice Address - Street 1:2000 JEFFERSON
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-5655
Practice Address - Country:US
Practice Address - Phone:217-228-2040
Practice Address - Fax:217-228-2042
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
148657OtherHEALTHLINK
182009OtherBLUE CROSS BLUE SHIELD
148657OtherHEALTHLINK