MEDICARE: DR. RANDALL DONALD HOLMES DC

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	5564	TX

General Provider Information

NPI Number	:	1588607204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL DONALD HOLMES DC

Provider Business Mailing Address
First Line	:	1235 NORTH LOOP WEST
Second Line	:	SUITE 105
City	:	HOUSTON
State	:	TX
Zip	:	77008-1772
Country	:	US
Telephone Number	:	713-862-2440
Fax Number	:	713-880-5193

Provider Business Practice Location Address
First Line	:	1235 NORTH LOOP WEST
Second Line	:	SUITE 105
City	:	HOUSTON
State	:	TX
Zip	:	77008-1772
Country	:	US
Telephone Number	:	713-862-2440
Fax Number	:	713-880-5193

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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