Provider Demographics
NPI:1881751378
Name:HOLTON, KEVIN (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:HOLTON
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 1:289 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1242
Mailing Address - Country:US
Mailing Address - Phone:732-549-0141
Mailing Address - Fax:732-632-2103
Practice Address - Street 1:289 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1242
Practice Address - Country:US
Practice Address - Phone:732-549-0141
Practice Address - Fax:732-632-2103
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00206200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T90329Medicare UPIN
NJ584895U6JMedicare ID - Type Unspecified