Provider Demographics
NPI:1205983772
Name:HOLT, J CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:J
Middle Name:CHARLES
Last Name:HOLT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
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:781-834-1164
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:781-834-1164
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADC987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHOY35868OtherBCBS INDIVIDUAL ID NUMBER
MAHOY39568OtherBCBS GROUP ID NUMBER
MAHOY39568OtherBCBS GROUP ID NUMBER