Provider Demographics
NPI:1467431650
Name:HOLT, TANYA K (DC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:K
Last Name:HOLT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 HEBER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8031
Mailing Address - Country:US
Mailing Address - Phone:870-251-2560
Mailing Address - Fax:870-251-3809
Practice Address - Street 1:163 HEBER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AR
Practice Address - Zip Code:72501-8031
Practice Address - Country:US
Practice Address - Phone:870-251-2560
Practice Address - Fax:870-251-3809
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125295718Medicaid
ARU41617Medicare UPIN