Healthcare Provider Details

I. General information

NPI: 1053368779
Provider Name (Legal Business Name): LARRY HOLT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9079 W POST RD STE 100
LAS VEGAS NV
89148-2414
US

IV. Provider business mailing address

9079 W POST RD STE 100
LAS VEGAS NV
89148-2414
US

V. Phone/Fax

Practice location:
  • Phone: 702-659-6509
  • Fax: 702-659-6509
Mailing address:
  • Phone: 702-659-6509
  • Fax: 702-659-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberB00739
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: