Healthcare Provider Details

I. General information

NPI: 1962533984
Provider Name (Legal Business Name): STEPHEN A HOLTZMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 VIDERA DR
EUGENE OR
97405-1248
US

IV. Provider business mailing address

3307 VIDERA DR
EUGENE OR
97405-1248
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-2034
  • Fax: 646-318-1932
Mailing address:
  • Phone: 541-342-2034
  • Fax: 646-318-1932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number651226
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: