Provider Demographics
NPI:1578568101
Name:HOLMES, HARRY THOMAS (DC)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:THOMAS
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 1:4350 S OLD US HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-8604
Mailing Address - Country:US
Mailing Address - Phone:810-229-6390
Mailing Address - Fax:810-229-9046
Practice Address - Street 1:4350 S OLD US HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-8604
Practice Address - Country:US
Practice Address - Phone:810-229-6390
Practice Address - Fax:810-229-9046
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301003069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350045912OtherPALMETTO GBA RAILROAD MED
MI950D710880OtherBLUE CROSS BLUE SHIELD
MI0D710880OtherBLUE CARE NETWORK
MI950D710880OtherFEDERAL BCBS
MICH470004OtherMCARE (U OF MICHIGAN)
MI104205OtherCARE CHOICES
MI1425605Medicaid
T33100Medicare UPIN
MI950D710880OtherBLUE CROSS BLUE SHIELD