Provider Demographics
NPI:1356520829
Name:HOLT CHIROPRACTIC CENTER, P.C
Entity type:Organization
Organization Name:HOLT CHIROPRACTIC CENTER, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-980-4914
Mailing Address - Street 1:17575 N FRUITPORT RD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1879
Mailing Address - Country:US
Mailing Address - Phone:517-980-4914
Mailing Address - Fax:
Practice Address - Street 1:4573 WILLOUGHBY RD
Practice Address - Street 2:STE B
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2188
Practice Address - Country:US
Practice Address - Phone:517-699-2646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICB008795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4470037Medicaid
MI0N94730Medicare PIN