Provider Demographics
NPI:1851483242
Name:HOLKUP, JACOB P (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:P
Last Name:HOLKUP
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:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:BEACH
Mailing Address - State:ND
Mailing Address - Zip Code:58621-0908
Mailing Address - Country:US
Mailing Address - Phone:701-872-7520
Mailing Address - Fax:701-872-7521
Practice Address - Street 1:110 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BEACH
Practice Address - State:ND
Practice Address - Zip Code:58621-4001
Practice Address - Country:US
Practice Address - Phone:701-872-7520
Practice Address - Fax:701-872-7521
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND729111N00000X
MI2301009112111N00000X
MN4356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002880Medicare ID - Type UnspecifiedMN MEDICARE
NDU95276Medicare UPIN
ND24379Medicare ID - Type UnspecifiedNORTH DAKOTA MEDICARE
MIQ24600008Medicare ID - Type UnspecifiedMICHIGAN MEDICARE