Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC30089 | CA |
NPI | 1265513600 |
---|---|
Provider Name | Dr. Benjamin Jeremy Holt |
First Address | Santa Barbara, CA 93103-2200 |
Second Address | Santa Barbara, CA 93103-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 07/12/2010 |