Healthcare Provider Details

I. General information

NPI: 1780761049
Provider Name (Legal Business Name): HOLTBY CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NW KINGWOOD AVE
REDMOND OR
97756-1349
US

IV. Provider business mailing address

725 NW KINGWOOD AVE
REDMOND OR
97756-1349
US

V. Phone/Fax

Practice location:
  • Phone: 541-550-7751
  • Fax:
Mailing address:
  • Phone: 541-550-7751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number713677
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number271763
License Number StateOR

VIII. Authorized Official

Name: DR. ALLEN DAYTON HARRISON
Title or Position: CHIRPRACTOR
Credential: D.C.
Phone: 541-923-0444