Provider Demographics
NPI:1881773745
Name:HOLMES, EDWARD C (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
Last Name:HOLMES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S FRETZ AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5783
Mailing Address - Country:US
Mailing Address - Phone:405-285-1429
Mailing Address - Fax:405-562-6996
Practice Address - Street 1:1400 S FRETZ AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5783
Practice Address - Country:US
Practice Address - Phone:405-285-1429
Practice Address - Fax:405-562-6996
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25338111N00000X
OK3908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U69440Medicare UPIN
OKOKB5884Medicare PIN