Provider Demographics
NPI:1184805897
Name:HOLT FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:HOLT FAMILY CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-834-4499
Mailing Address - Street 1:696 PLAIN ST
Mailing Address - Street 2:SUITE #1A
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2100
Mailing Address - Country:US
Mailing Address - Phone:781-834-4499
Mailing Address - Fax:
Practice Address - Street 1:696 PLAIN ST
Practice Address - Street 2:SUITE #1A
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2100
Practice Address - Country:US
Practice Address - Phone:781-834-4499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADC 987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35868OtherBCBSMA INDIVIDUAL
MA1607065OtherMASS HEALTH
MAY39568OtherBCBSMA GROUP
MA721-614OtherTUFTS
MAT58441Medicare UPIN
MA721-614OtherTUFTS