Provider Demographics
NPI:1215327721
Name:HOLMAN, KEVIN (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:HOLMAN
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 1:1260 S FRONTAGE RD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033
Mailing Address - Country:US
Mailing Address - Phone:651-243-0633
Mailing Address - Fax:
Practice Address - Street 1:1260 S FRONTAGE RD.
Practice Address - Street 2:SUITE B
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033
Practice Address - Country:US
Practice Address - Phone:651-243-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6957111N00000X
COCHR0007230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor