Provider Demographics
NPI:1093927626
Name:HOLLARS, RODNEY DALE (DC)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:DALE
Last Name:HOLLARS
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 1:4059 SOUTH 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1656
Mailing Address - Country:US
Mailing Address - Phone:502-368-7224
Mailing Address - Fax:502-368-7224
Practice Address - Street 1:4059 SOUTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-1656
Practice Address - Country:US
Practice Address - Phone:502-368-7224
Practice Address - Fax:502-368-7224
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor