Provider Demographics
NPI:1447289061
Name:HOLT, JEFFREY W (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:HOLT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JEFFREY
Other - Middle Name:W
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHIROPRACTOR PA
Mailing Address - Street 1:PO BOX 1838
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560
Mailing Address - Country:US
Mailing Address - Phone:870-269-5678
Mailing Address - Fax:870-269-5838
Practice Address - Street 1:103 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560
Practice Address - Country:US
Practice Address - Phone:870-269-5678
Practice Address - Fax:870-269-5838
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U62925Medicare UPIN
AR5T359Medicare ID - Type Unspecified