Healthcare Provider Details

I. General information

NPI: 1104908136
Provider Name (Legal Business Name): HOLTEN CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7677 PARAGON RD # D1
CENTERVILLE OH
45459-4068
US

IV. Provider business mailing address

7677 PARAGON RD # D1
CENTERVILLE OH
45459-4068
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-8480
  • Fax:
Mailing address:
  • Phone: 937-435-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2369
License Number StateOH

VIII. Authorized Official

Name: DR. MATTHEW A HOLTEN
Title or Position: OWNER
Credential: D.C.
Phone: 937-435-8480