Provider Demographics
NPI:1346203676
Name:HOLMES, MATTHEW TURNER (DC, CCEP)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TURNER
Last Name:HOLMES
Suffix:
Gender:M
Credentials:DC, CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 PARLEYS WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1636
Mailing Address - Country:US
Mailing Address - Phone:801-485-4455
Mailing Address - Fax:801-485-2255
Practice Address - Street 1:2645 PARLEYS WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1636
Practice Address - Country:US
Practice Address - Phone:801-485-4455
Practice Address - Fax:801-485-2255
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT349519-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056203Medicare ID - Type Unspecified