Provider Demographics
NPI:1215245824
Name:HOLTWICK, CORY JAMES (DC NP-C)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:JAMES
Last Name:HOLTWICK
Suffix:
Gender:M
Credentials:DC NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 NE 82ND TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-1313
Mailing Address - Country:US
Mailing Address - Phone:816-437-8122
Mailing Address - Fax:816-407-9609
Practice Address - Street 1:8880 NE 82ND TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1313
Practice Address - Country:US
Practice Address - Phone:816-437-8122
Practice Address - Fax:816-407-9609
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5251111N00000X
NMRN-80240163W00000X
NMCNP-02496363LF0000X
MO2016030152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5251OtherCHIROPRACTIC LICENSE NUMBER