Provider Demographics
NPI:1255313037
Name:HOLTZMAN, JONATHAN R (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:R
Last Name:HOLTZMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:107 RIDGELY AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1417
Mailing Address - Country:US
Mailing Address - Phone:410-267-6701
Mailing Address - Fax:410-267-0667
Practice Address - Street 1:107 RIDGELY AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1417
Practice Address - Country:US
Practice Address - Phone:410-267-6701
Practice Address - Fax:410-267-0667
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1896083OtherFIRST HEALTH
MDS867-001OtherBC/BS FEP
DCS867-001OtherCAREFIRST/DC BC/BS
VA259128OtherANTHEM BC/BS
MD7864230OtherAETNA PPO/HMO
MDKAX3OtherCAREFIRST/MD BC/BS
MD2791946OtherUNITED HMO
VA44-00577OtherUNITED PPO
MD7864230OtherUNITED PPO
MD1896083OtherFIRST HEALTH
MD7864230OtherAETNA PPO/HMO