Provider Demographics
NPI:1811080112
Name:HOLTZMAN, GREGORY MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MICHAEL
Last Name:HOLTZMAN
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 1:2640 MINER RD
Mailing Address - Street 2:
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-4437
Mailing Address - Country:US
Mailing Address - Phone:580-585-5600
Mailing Address - Fax:
Practice Address - Street 1:2640 MINER RD
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-4437
Practice Address - Country:US
Practice Address - Phone:580-248-4212
Practice Address - Fax:580-248-4214
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5665360OtherPPO CCN