=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194025825
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLMES CHIROPRACTIC AND SPORTS REHABILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2010
-----------------------------------------------------
Last Update Date | 10/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 52 TENNENT RD
-----------------------------------------------------
City | MORGANVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07751-4153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-598-6200
-----------------------------------------------------
Fax | 732-592-1233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 52 TENNENT RD
-----------------------------------------------------
City | MORGANVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07751-4153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-598-6200
-----------------------------------------------------
Fax | 732-592-1233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTIC PHYSICIAN
-----------------------------------------------------
Name | DR. CHRISTOPHER PATRICK HOLMES
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 732-598-6200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00671000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------