MEDICARE: TIMOTHY RAY HOLMES DC

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	B00552	NV

General Provider Information

NPI Number	:	1578540605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY RAY HOLMES DC

Provider Business Mailing Address
First Line	:	1420 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1231
Country	:	US
Telephone Number	:	702-312-2225
Fax Number	:	702-312-2230

Provider Business Practice Location Address
First Line	:	1420 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1231
Country	:	US
Telephone Number	:	702-312-2225
Fax Number	:	702-312-2230

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	06/12/2014

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Directions to “ TIMOTHY RAY HOLMES DC” Practice Location

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