Provider Demographics
NPI:1710313929
Name:HOLMAN, JACOBE MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOBE
Middle Name:MARK
Last Name:HOLMAN
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 1:300 NICKEL ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2013
Mailing Address - Country:US
Mailing Address - Phone:720-255-3722
Mailing Address - Fax:
Practice Address - Street 1:300 NICKEL ST
Practice Address - Street 2:SUITE 9
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2013
Practice Address - Country:US
Practice Address - Phone:720-255-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor