Provider Demographics
NPI:1811206600
Name:HOLTWICK CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:HOLTWICK CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOLTWICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-882-5775
Mailing Address - Street 1:321 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1565
Mailing Address - Country:US
Mailing Address - Phone:660-882-5775
Mailing Address - Fax:660-882-5995
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1565
Practice Address - Country:US
Practice Address - Phone:660-882-5775
Practice Address - Fax:660-882-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000031522Medicare PIN
T43587Medicare UPIN