Provider Demographics
NPI:1609559053
Name:HOLDERMAN DC, PAYTON JAMES (DC)
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:JAMES
Last Name:HOLDERMAN DC
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 1:2821 MCKINNEY AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2549
Mailing Address - Country:US
Mailing Address - Phone:979-255-4949
Mailing Address - Fax:
Practice Address - Street 1:2821 MCKINNEY AVE STE 3
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2549
Practice Address - Country:US
Practice Address - Phone:979-255-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor