Provider Demographics
NPI:1285716688
Name:HOLMAN, TERRY L (DC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:L
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 1:620 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-1868
Mailing Address - Country:US
Mailing Address - Phone:419-592-8186
Mailing Address - Fax:419-592-8101
Practice Address - Street 1:620 MONROE ST
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1868
Practice Address - Country:US
Practice Address - Phone:419-592-8186
Practice Address - Fax:419-592-8101
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000165743OtherANTHEM
OH03477OtherPARAMOUNT
OH0514072Medicaid
OHH00528621Medicare ID - Type Unspecified
OH0514072Medicaid