Individual
DR. JEFFREY L HOLMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
17615 85TH AVENUE CT E, PUYALLUP, WA 98375-1859
(253) 848-6603
Mailing address
17615 85TH AVENUE CT E, PUYALLUP, WA 98375-1859
(253) 848-6603
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
2705
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2705
WA CHIRO LICENSE #
WA
01
—
31159
L&I
WA
01
—
350050140
RAILROAD MEDICARE
WA
01
—
5448436
AETNA PROVIDER #
WA
01
—
601-879-408
WA UBI#
WA
01
—
91-192704
FEDERAL TAX ID #
WA
01
—
H04731
REGENCE
WA
Enumeration date
08/17/2006
Last updated
05/04/2018
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