MEDICARE: HOLMES SPINE & SPORT CHIROPRACTIC CLINIC INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1184738296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLMES SPINE & SPORT CHIROPRACTIC CLINIC INC.

Provider Business Mailing Address
First Line	:	1245 GLEN DR
Second Line	:
City	:	MILLERSBURG
State	:	OH
Zip	:	44654-8958
Country	:	US
Telephone Number	:	330-674-0444
Fax Number	:	330-674-0802

Provider Business Practice Location Address
First Line	:	1245 GLEN DR
Second Line	:
City	:	MILLERSBURG
State	:	OH
Zip	:	44654-8958
Country	:	US
Telephone Number	:	330-674-0444
Fax Number	:	330-674-0802

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. REX A SMETZER
Credential	:
Telephone Number	:	330-674-0444

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	03/29/2012

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