Healthcare Provider Details

I. General information

NPI: 1740451822
Provider Name (Legal Business Name): HOLDAHL FAMILY CHIROPRACTIC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 HIGHWAY 6 AND 50 STE B
FRUITA CO
81521-2642
US

IV. Provider business mailing address

1227 N GOERIG ST STE H
WOODLAND WA
98674-9741
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-0544
  • Fax: 970-858-7749
Mailing address:
  • Phone: 360-225-1200
  • Fax: 360-225-1266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0034287
License Number StateWA

VIII. Authorized Official

Name: JASON HOLDAHL
Title or Position: PRESIDENT
Credential: DC
Phone: 360-225-1200