Provider Demographics
NPI:1689771081
Name:HOLMES, JEREMIAH (DC)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:HOLMES
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 1:455 ARMCO RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7370
Mailing Address - Country:US
Mailing Address - Phone:859-203-5100
Mailing Address - Fax:
Practice Address - Street 1:455 ARMCO RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7370
Practice Address - Country:US
Practice Address - Phone:606-326-1132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1060111N00000X
KY4806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2241149Medicaid
KY85002764Medicaid
OH2241149Medicaid
KY85002764Medicaid