Provider Demographics
NPI:1699015883
Name:HOLST, ZACHARY JAMES (DC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JAMES
Last Name:HOLST
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 1:704 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1325
Mailing Address - Country:US
Mailing Address - Phone:563-659-9935
Mailing Address - Fax:563-659-3243
Practice Address - Street 1:2807 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-3335
Practice Address - Country:US
Practice Address - Phone:319-233-6363
Practice Address - Fax:319-233-6262
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007538111N00000X
IL038012362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor