Healthcare Provider Details

I. General information

NPI: 1871530717
Provider Name (Legal Business Name): HOLDAHL FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 GOERIG RD
WOODLAND WA
98674-9515
US

IV. Provider business mailing address

316 HIGHWAY 6 AND 50
FRUITA CO
81521-2642
US

V. Phone/Fax

Practice location:
  • Phone: 360-225-1200
  • Fax: 360-225-1266
Mailing address:
  • Phone: 970-858-0544
  • Fax: 970-858-7749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034287
License Number StateWA

VIII. Authorized Official

Name: DR. JASON HOLDAHL
Title or Position: OWNER
Credential:
Phone: 360-225-1200