Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1729 | NE |
NPI | 1306192331 |
---|---|
Provider Name | Dr. Charles Joseph Holcomb |
First Address | Omaha, NE 68104-3839 |
Second Address | Omaha, NE 68104-3839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2012 |
Last Update Date | 22/06/2015 |