Provider Demographics
NPI:1558378810
Name:HOLT, MATTHEW B (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:HOLT
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 1:2609 ENCINO AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-2739
Mailing Address - Country:US
Mailing Address - Phone:808-214-8408
Mailing Address - Fax:979-476-3141
Practice Address - Street 1:2129 AVENUE G
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-5023
Practice Address - Country:US
Practice Address - Phone:808-214-8408
Practice Address - Fax:979-476-3141
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10359111N00000X
HI1094111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician