Provider Demographics
NPI:1013054873
Name:HOLTSCHLAG, CATHERINE M (DC)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:M
Last Name:HOLTSCHLAG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W WOOD ST
Mailing Address - Street 2:
Mailing Address - City:CAMP POINT
Mailing Address - State:IL
Mailing Address - Zip Code:62320-1301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:217-593-6399
Practice Address - Street 1:207 W WOOD ST
Practice Address - Street 2:
Practice Address - City:CAMP POINT
Practice Address - State:IL
Practice Address - Zip Code:62320-1301
Practice Address - Country:US
Practice Address - Phone:217-593-6399
Practice Address - Fax:217-593-6399
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-0007811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0000108493OtherBLUE SHIELD
IL384900Medicare ID - Type Unspecified