Healthcare Provider Details

I. General information

NPI: 1306192331
Provider Name (Legal Business Name): CHARLES JOSEPH HOLCOMB D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6918 MAPLE ST
OMAHA NE
68104-3839
US

IV. Provider business mailing address

6918 MAPLE ST
OMAHA NE
68104-3839
US

V. Phone/Fax

Practice location:
  • Phone: 402-571-3039
  • Fax:
Mailing address:
  • Phone: 402-571-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1729
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: