Healthcare Provider Details

I. General information

NPI: 1942260658
Provider Name (Legal Business Name): CHARLES R. HOLT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E BEEBE CAPPS EXPY
SEARCY AR
72143-6887
US

IV. Provider business mailing address

1201 E BEEBE CAPPS EXPY
SEARCY AR
72143-6887
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-3030
  • Fax: 501-268-3032
Mailing address:
  • Phone: 501-268-3030
  • Fax: 501-268-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1324
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: