Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038.013007 | IL |
NPI | 1003361783 |
---|---|
Provider Name | Dr. Weston Allen Holzinger |
First Address | Highland, IL 62249-1034 |
Second Address | O Fallon, IL 62269-1848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2016 |
Last Update Date | 23/08/2016 |