Provider Demographics
NPI:1164078978
Name:HOLLY CHIROPRACTIC & SPORTS REHAB LLC
Entity Type:Organization
Organization Name:HOLLY CHIROPRACTIC & SPORTS REHAB LLC
Other - Org Name:HOLLY CHIROPRACTIC & SPORTS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-522-3500
Mailing Address - Street 1:1414 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4650
Mailing Address - Country:US
Mailing Address - Phone:970-522-3500
Mailing Address - Fax:970-522-3509
Practice Address - Street 1:1414 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4650
Practice Address - Country:US
Practice Address - Phone:970-522-3500
Practice Address - Fax:970-522-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty