Healthcare Provider Details

I. General information

NPI: 1073760054
Provider Name (Legal Business Name): JON HOLTZMAN CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 RIDGELY AVE SUITE 11
ANNAPOLIS MD
21401-1417
US

IV. Provider business mailing address

107 RIDGELY AVE SUITE 11
ANNAPOLIS MD
21401-1417
US

V. Phone/Fax

Practice location:
  • Phone: 410-267-6701
  • Fax: 410-267-0667
Mailing address:
  • Phone: 410-267-6701
  • Fax: 410-267-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number02063
License Number StateMD

VIII. Authorized Official

Name: DR. JONATHAN R. HOLTZMAN
Title or Position: OWNER
Credential: D.C.
Phone: 410-267-6701