Provider Demographics
NPI:1740451822
Name:HOLDAHL FAMILY CHIROPRACTIC PS
Entity type:Organization
Organization Name:HOLDAHL FAMILY CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-225-1200
Mailing Address - Street 1:1227 N GOERIG ST STE H
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-9741
Mailing Address - Country:US
Mailing Address - Phone:360-225-1200
Mailing Address - Fax:360-225-1266
Practice Address - Street 1:316 HIGHWAY 6 AND 50 STE B
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2642
Practice Address - Country:US
Practice Address - Phone:970-858-0544
Practice Address - Fax:970-858-7749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0034287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty