Provider Demographics
NPI:1003028663
Name:HOLLERBACH, MICHAEL R (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:HOLLERBACH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10345 WATERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571-9176
Mailing Address - Country:US
Mailing Address - Phone:419-419-3800
Mailing Address - Fax:419-830-4020
Practice Address - Street 1:10345 WATERVILLE ST
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:OH
Practice Address - Zip Code:43571-9176
Practice Address - Country:US
Practice Address - Phone:419-419-3800
Practice Address - Fax:419-830-4020
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2018-03-01
Deactivation Date:2018-01-04
Deactivation Code:
Reactivation Date:2018-02-27
Provider Licenses
StateLicense IDTaxonomies
OHDC04784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor