Provider Demographics
NPI:1316932692
Name:HOLMES, PAUL ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
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 1:1412 N GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-3140
Mailing Address - Country:US
Mailing Address - Phone:432-366-5848
Mailing Address - Fax:432-367-4167
Practice Address - Street 1:1412 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-3140
Practice Address - Country:US
Practice Address - Phone:432-366-5848
Practice Address - Fax:432-367-4167
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0020810-01Medicaid
TX8F21119Medicare PIN