Provider Demographics
NPI:1689765463
Name:HOLDER, PRESTON SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:SCOTT
Last Name:HOLDER
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 1:2128 SILVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-4831
Mailing Address - Country:US
Mailing Address - Phone:706-267-6486
Mailing Address - Fax:
Practice Address - Street 1:3106 WRIGHTSBORO RD
Practice Address - Street 2:SUITE A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-0307
Practice Address - Country:US
Practice Address - Phone:706-733-7577
Practice Address - Fax:706-733-1940
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor