Provider Demographics
NPI:1881708980
Name:HOLYOKE, EDWARD (DC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:HOLYOKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 5TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2671
Mailing Address - Country:US
Mailing Address - Phone:509-758-7258
Mailing Address - Fax:509-758-7258
Practice Address - Street 1:733 5TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2671
Practice Address - Country:US
Practice Address - Phone:509-758-7258
Practice Address - Fax:509-758-7258
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA780111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000010007133OtherREGENCE BLUE SHIELD
WAC9768OtherBLUE CROSS OF IDAHO
WA780OtherWA STATE LICENSE NUMBER