Provider Demographics
NPI:1689713455
Name:HOLM JOHANSEN, JON EIRIK (DC)
Entity Type:Individual
Prefix:DR
First Name:JON EIRIK
Middle Name:
Last Name:HOLM JOHANSEN
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 1:2180 W EISENHOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3146
Mailing Address - Country:US
Mailing Address - Phone:970-203-0597
Mailing Address - Fax:970-203-0654
Practice Address - Street 1:2180 W EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3146
Practice Address - Country:US
Practice Address - Phone:970-203-0597
Practice Address - Fax:970-203-0654
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCJ0323Medicare ID - Type Unspecified