Healthcare Provider Details

I. General information

NPI: 1922189133
Provider Name (Legal Business Name): DAVID WAYNE HOLTWICK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MAIN ST
BOONVILLE MO
65233-1565
US

IV. Provider business mailing address

321 MAIN ST
BOONVILLE MO
65233-1565
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-5775
  • Fax: 660-882-5995
Mailing address:
  • Phone: 660-882-5775
  • Fax: 660-882-5995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4723
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: