Healthcare Provider Details

I. General information

NPI: 1992874127
Provider Name (Legal Business Name): RALPH BERT HOLTBY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
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

6961 NE 1ST ST
REDMOND OR
97756-8756
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-0444
  • Fax: 541-923-0444
Mailing address:
  • Phone: 541-548-7532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number271763
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: