Provider Demographics
NPI:1043320286
Name:HOLIFIELD, BROOKS (DC)
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:
Last Name:HOLIFIELD
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 1214
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78364-1214
Mailing Address - Country:US
Mailing Address - Phone:361-592-6557
Mailing Address - Fax:361-592-0064
Practice Address - Street 1:830 E CAESAR AVE
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-6363
Practice Address - Country:US
Practice Address - Phone:361-592-6557
Practice Address - Fax:361-592-0064
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7230111NN0400X
AR1268111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1789216-01Medicaid
TX606274OtherBCBS
TX1789216-01Medicaid
TX609612Medicare ID - Type Unspecified