Provider Demographics
NPI:1770883381
Name:HOLDAHL CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:HOLDAHL CHIROPRACTIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEARER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-852-1801
Mailing Address - Street 1:1227 N GOERIG ST
Mailing Address - Street 2:STE H
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 1:1227 N GOERIG ST
Practice Address - Street 2:STE H
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-9741
Practice Address - Country:US
Practice Address - Phone:360-225-1200
Practice Address - Fax:360-225-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034737261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center