Healthcare Provider Details

I. General information

NPI: 1790888303
Provider Name (Legal Business Name): PETER A HOLST DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E MAIN ST
MIDDLETOWN NY
10940
US

IV. Provider business mailing address

450 E MAIN ST
MIDDLETOWN NY
10940
US

V. Phone/Fax

Practice location:
  • Phone: 845-344-0444
  • Fax: 845-344-0456
Mailing address:
  • Phone: 845-344-0444
  • Fax: 845-344-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number042811
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: