Healthcare Provider Details

I. General information

NPI: 1881708980
Provider Name (Legal Business Name): EDWARD HOLYOKE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 5TH ST SUITE E
CLARKSTON WA
99403-2671
US

IV. Provider business mailing address

733 5TH ST SUITE E
CLARKSTON WA
99403-2671
US

V. Phone/Fax

Practice location:
  • Phone: 509-758-7258
  • Fax: 509-758-7258
Mailing address:
  • Phone: 509-758-7258
  • Fax: 509-758-7258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberWA780
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: