Provider Demographics
NPI:1710966858
Name:HOLDEN, LES M JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LES
Middle Name:M
Last Name:HOLDEN
Suffix:JR
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 1:1500 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2820
Mailing Address - Country:US
Mailing Address - Phone:479-968-2044
Mailing Address - Fax:479-968-2044
Practice Address - Street 1:1500 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4853
Practice Address - Country:US
Practice Address - Phone:479-968-2044
Practice Address - Fax:479-968-2044
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR263403469OtherTAX ID
AR5U105OtherBLUE CROSS BLUS SHIELD
AR263403469OtherTAX ID