Healthcare Provider Details

I. General information

NPI: 1235273343
Provider Name (Legal Business Name): KIRBY W HOLTMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20963 BILL STEPHENS DR.
CHUGIAK AK
99567
US

IV. Provider business mailing address

PO BOX 670367
CHUGIAK AK
99567-0367
US

V. Phone/Fax

Practice location:
  • Phone: 907-688-7676
  • Fax:
Mailing address:
  • Phone: 907-688-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number292
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: