Provider Demographics
NPI:1235273343
Name:HOLTMAN, KIRBY W (DC)
Entity Type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:W
Last Name:HOLTMAN
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:PO BOX 670367
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-0367
Mailing Address - Country:US
Mailing Address - Phone:907-688-7676
Mailing Address - Fax:
Practice Address - Street 1:20963 BILL STEPHENS DR.
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567
Practice Address - Country:US
Practice Address - Phone:907-688-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHO292Medicaid
AKU61961Medicare UPIN
0000QGHGXMedicare ID - Type Unspecified