Provider Demographics
NPI:1386266781
Name:HOLOP, CODY MATTHEW
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:MATTHEW
Last Name:HOLOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13003 SE KENT KANGLEY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7919
Mailing Address - Country:US
Mailing Address - Phone:253-638-2424
Mailing Address - Fax:
Practice Address - Street 1:13003 SE KENT KANGLEY RD STE 110
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7919
Practice Address - Country:US
Practice Address - Phone:253-638-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA208D00000X111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty