Provider Demographics
NPI:1386781441
Name:HOLMES, PAUL JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
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 1:45 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1532
Mailing Address - Country:US
Mailing Address - Phone:781-245-6282
Mailing Address - Fax:
Practice Address - Street 1:11 LAKESIDE OFFICE PARK
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1309
Practice Address - Country:US
Practice Address - Phone:781-246-4433
Practice Address - Fax:781-246-4468
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1574111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHO-Y45843Medicare ID - Type UnspecifiedMEDICARE B PROVIDER