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General NPI Number Information
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NPI Number | 1508454737
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Entity Type | Individual
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Provider Name | PAYTON HOLMES DC
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Gender | Male
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 107 N MAIN ST
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City | MONMOUTH
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State | IL
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Zip | 61462-1738
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Country | US
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Telephone | 309-299-6968
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Fax |
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Provider Business Mailing Address
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Address Line | 510 NE 6TH AVE
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City | ALEDO
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State | IL
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Zip | 61231-1155
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Country | US
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Telephone | 309-299-6968
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.013623
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License Number State | IL
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