Provider Demographics
NPI:1437227428
Name:HOLT, THOMAS W (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:HOLT
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 1:2501 SE MILE HILL DR
Mailing Address - Street 2:STE. 103
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3500
Mailing Address - Country:US
Mailing Address - Phone:360-874-0232
Mailing Address - Fax:360-874-0658
Practice Address - Street 1:2501 SE MILE HILL DR
Practice Address - Street 2:STE. 103
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3500
Practice Address - Country:US
Practice Address - Phone:360-874-0232
Practice Address - Fax:360-874-0658
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA CH0003171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA104778OtherWASHINGTON STATE L&I
WAP00083899OtherMEDICARE RAILROAD
WAHO5011OtherBLUE SHIELD REGENCE
WAP00083899OtherMEDICARE RAILROAD
WA115000745Medicare ID - Type Unspecified