Provider Demographics
NPI:1992940431
Name:HOLMES, DAVID RANDOLPH (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RANDOLPH
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 1:11060 HUNTING HAWK RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89179-2043
Mailing Address - Country:US
Mailing Address - Phone:612-743-3202
Mailing Address - Fax:877-640-3412
Practice Address - Street 1:11060 HUNTING HAWK RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89179-2043
Practice Address - Country:US
Practice Address - Phone:612-743-3202
Practice Address - Fax:877-640-3412
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5127111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician