Healthcare Provider Details

I. General information

NPI: 1215245824
Provider Name (Legal Business Name): CORY JAMES HOLTWICK D.C. NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 NE 82ND TER
KANSAS CITY MO
64158-1313
US

IV. Provider business mailing address

8880 NE 82ND TER
KANSAS CITY MO
64158-1313
US

V. Phone/Fax

Practice location:
  • Phone: 816-437-8122
  • Fax: 816-407-9609
Mailing address:
  • Phone: 816-437-8122
  • Fax: 816-407-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5251
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-80240
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02496
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016030152
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: