1790297554 NPI number — DR. PAUL PHILLIP HOLDERFIELD III D.C.

Table of content: DR. PAUL PHILLIP HOLDERFIELD III D.C. (NPI 1790297554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790297554 NPI number — DR. PAUL PHILLIP HOLDERFIELD III D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLDERFIELD
Provider First Name:
PAUL
Provider Middle Name:
PHILLIP
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
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:
1790297554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 N PINE ST APT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72114-5700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-350-4154
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14300 CANTRELL RD STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72223-4216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-367-5184
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2017

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:  16171 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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