Provider Demographics
NPI:1578844353
Name:HOLZBACH, JEREMIAH LE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:LE
Last Name:HOLZBACH
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 1:330 GENESIS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1638
Mailing Address - Country:US
Mailing Address - Phone:281-724-1620
Mailing Address - Fax:281-968-0618
Practice Address - Street 1:330 GENESIS BLVD STE B
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1638
Practice Address - Country:US
Practice Address - Phone:281-724-1620
Practice Address - Fax:281-968-0618
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor