Provider Demographics
NPI:1922154947
Name:HOLMES CHIROPRACTIC INC
Entity Type:Organization
Organization Name:HOLMES CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-858-5152
Mailing Address - Street 1:11511 CANTERWOOD BLVD NW
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5813
Mailing Address - Country:US
Mailing Address - Phone:253-858-5152
Mailing Address - Fax:253-858-5153
Practice Address - Street 1:11511 CANTERWOOD BLVD NW
Practice Address - Street 2:SUITE 210
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5813
Practice Address - Country:US
Practice Address - Phone:253-858-5152
Practice Address - Fax:253-858-5153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH2999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8854860Medicare PIN
WAU51323Medicare UPIN