Provider Demographics
NPI:1578540605
Name:HOLMES, TIMOTHY RAY (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAY
Last Name:HOLMES
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 1:1420 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1231
Mailing Address - Country:US
Mailing Address - Phone:702-312-2225
Mailing Address - Fax:702-312-2230
Practice Address - Street 1:1420 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1231
Practice Address - Country:US
Practice Address - Phone:702-312-2225
Practice Address - Fax:702-312-2230
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor