Provider Demographics
NPI:1457652844
Name:HOLDER, DAVID ROY (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROY
Last Name:HOLDER
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 1:886 W FOOTHILL BLVD
Mailing Address - Street 2:STE E
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3780
Mailing Address - Country:US
Mailing Address - Phone:909-946-2673
Mailing Address - Fax:909-946-1872
Practice Address - Street 1:886 W FOOTHILL BLVD
Practice Address - Street 2:STE E
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3780
Practice Address - Country:US
Practice Address - Phone:909-946-2673
Practice Address - Fax:909-946-1872
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor