Provider Demographics
NPI:1427022136
Name:HOLTON, NICHOLAS T (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:T
Last Name:HOLTON
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 1004
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:IA
Mailing Address - Zip Code:51024-1004
Mailing Address - Country:US
Mailing Address - Phone:712-947-4100
Mailing Address - Fax:712-947-4110
Practice Address - Street 1:1212 STARVIEW DR
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:IA
Practice Address - Zip Code:51024
Practice Address - Country:US
Practice Address - Phone:712-947-4100
Practice Address - Fax:712-947-4110
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA439844Medicaid
IAI11730Medicare ID - Type Unspecified
IA439844Medicaid