1558378810 NPI number — MATTHEW B HOLT D.C.

Table of content: MATTHEW B HOLT D.C. (NPI 1558378810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558378810 NPI number — MATTHEW B HOLT D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLT
Provider First Name:
MATTHEW
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558378810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2609 ENCINO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77414-2739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-214-8408
Provider Business Mailing Address Fax Number:
979-476-3141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2129 AVENUE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77414-5023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-214-8408
Provider Business Practice Location Address Fax Number:
979-476-3141
Provider Enumeration Date:
08/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  10359 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NS0005X , with the licence number: 1094 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)