Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | IL |
NPI | 1144348806 |
---|---|
Provider Name | Dr. J Steven Holcomb |
First Address | Naperville, IL 60567-4015 |
Second Address | Naperville, IL 60563-8965 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022-90109 | BCBS (01) | IL |
U38228 | (02) | IL |