Provider Demographics
NPI:1215016845
Name:HOLT, DAN A (DC)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:A
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 1:1900 LAMY LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-9207
Mailing Address - Country:US
Mailing Address - Phone:318-322-2639
Mailing Address - Fax:318-322-2419
Practice Address - Street 1:1900 LAMY LN
Practice Address - Street 2:SUITE A
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-9207
Practice Address - Country:US
Practice Address - Phone:318-322-2639
Practice Address - Fax:318-322-2419
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH3300OtherBLUE CROSS BLUE SHIELD