Provider Demographics
NPI:1134301278
Name:HOLLOWAY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:HOLLOWAY CHIROPRACTIC PLLC
Other - Org Name:HOLLOWAY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC 9166
Authorized Official - Phone:210-525-8550
Mailing Address - Street 1:7109 BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5022
Mailing Address - Country:US
Mailing Address - Phone:210-525-8550
Mailing Address - Fax:210-525-8575
Practice Address - Street 1:7109 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5022
Practice Address - Country:US
Practice Address - Phone:210-525-8550
Practice Address - Fax:210-525-8575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLLOWAY CHIROPRACTIC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-30
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F7860OtherBLUE CROSS BLUE SHIELD
8436B0Medicare UPIN
00208TMedicare PIN