MEDICARE: DR. THOMAS W. HOLT D.C.

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	WA CH0003171	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00083899	OTHER	WA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104778	OTHER	WA	WASHINGTON STATE L&I
3	HO5011	OTHER	WA	BLUE SHIELD REGENCE

General Provider Information

NPI Number	:	1437227428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS W. HOLT D.C.

Provider Business Mailing Address
First Line	:	2501 SE MILE HILL DR
Second Line	:	STE. 103
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3500
Country	:	US
Telephone Number	:	360-874-0232
Fax Number	:	360-874-0658

Provider Business Practice Location Address
First Line	:	2501 SE MILE HILL DR
Second Line	:	STE. 103
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3500
Country	:	US
Telephone Number	:	360-874-0232
Fax Number	:	360-874-0658

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	04/30/2010

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