Provider Demographics
NPI:1407937964
Name:HOLMAN, RANDY KENNITH (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:KENNITH
Last Name:HOLMAN
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 1:7915 FM 1960 RD W
Mailing Address - Street 2:SUITE 175
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5716
Mailing Address - Country:US
Mailing Address - Phone:281-890-7710
Mailing Address - Fax:281-894-1458
Practice Address - Street 1:7915 FM 1960 RD W
Practice Address - Street 2:SUITE 175
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5716
Practice Address - Country:US
Practice Address - Phone:281-890-7710
Practice Address - Fax:281-894-1458
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760443581OtherTAX ID NUMBER
TX760443581OtherTAX ID NUMBER
TX605032Medicare ID - Type UnspecifiedLEGACY PROVIDER NUMBER