Provider Demographics
NPI:1720218183
Name:HOLD, BRIAN GAYLORD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:GAYLORD
Last Name:HOLD
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 1:705 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4202
Mailing Address - Country:US
Mailing Address - Phone:219-286-2565
Mailing Address - Fax:
Practice Address - Street 1:705 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4202
Practice Address - Country:US
Practice Address - Phone:219-286-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1343111N00000X
IN08002545A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor