Provider Demographics
NPI:1619177540
Name:HOLCOMB, JERRY JOE JR (ND)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:JOE
Last Name:HOLCOMB
Suffix:JR
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 N MAIN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-7744
Mailing Address - Country:US
Mailing Address - Phone:435-586-4854
Mailing Address - Fax:
Practice Address - Street 1:1870 N MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-7744
Practice Address - Country:US
Practice Address - Phone:435-586-4854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6626816-7101175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath