Provider Demographics
NPI:1477654382
Name:HOLDEN, JOHN G (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:HOLDEN
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 1:728 CASCADE PALMS CT.
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284
Mailing Address - Country:US
Mailing Address - Phone:360-661-0121
Mailing Address - Fax:360-416-3209
Practice Address - Street 1:728 CASCADE PALMS CT.
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284
Practice Address - Country:US
Practice Address - Phone:360-661-0121
Practice Address - Fax:360-416-3209
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0003044111N00000X
WACH00003044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG115200758Medicare PIN
WAG115200758Medicare PIN