Provider Demographics
NPI:1346424074
Name:EDWARD C HOLMES CHIROPRACTIC PC
Entity Type:Organization
Organization Name:EDWARD C HOLMES CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-315-2897
Mailing Address - Street 1:814 PINE OAK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4650
Mailing Address - Country:US
Mailing Address - Phone:405-315-2897
Mailing Address - Fax:405-315-2897
Practice Address - Street 1:814 PINE OAK DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4650
Practice Address - Country:US
Practice Address - Phone:405-315-2897
Practice Address - Fax:405-315-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2132687Medicaid
OH2132687Medicaid
OHU69440Medicare UPIN