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General NPI Number Information
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NPI Number | 1811206600
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Entity Type | Organization
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Legal Business Name | HOLTWICK CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 321 MAIN ST
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City | BOONVILLE
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State | MO
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Zip | 65233-1565
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Country | US
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Telephone | 660-882-5775
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Fax | 660-882-5995
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Provider Business Mailing Address
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Address Line | 321 MAIN ST
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City | BOONVILLE
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State | MO
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Zip | 65233-1565
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Country | US
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Telephone | 660-882-5775
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Fax | 660-882-5995
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID WAYNE HOLTWICK
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Credential | D.C.
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Telephone | 660-882-5775
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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 | 4723
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License Number State | MO
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