MEDICARE: PAUL ANTHONY HOLMES D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	8253	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316932692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ANTHONY HOLMES D.C.

Provider Business Mailing Address
First Line	:	1412 N GRANDVIEW AVE
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-3140
Country	:	US
Telephone Number	:	432-366-5848
Fax Number	:	432-367-4167

Provider Business Practice Location Address
First Line	:	1412 N GRANDVIEW AVE
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-3140
Country	:	US
Telephone Number	:	432-366-5848
Fax Number	:	432-367-4167

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	11/18/2009

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