Provider Demographics
NPI:1235291931
Name:HOLLAND, GARY J (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:HOLLAND
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 1:31166 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-4277
Mailing Address - Country:US
Mailing Address - Phone:248-477-6400
Mailing Address - Fax:
Practice Address - Street 1:31166 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-4277
Practice Address - Country:US
Practice Address - Phone:248-477-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OF35357OtherBCBSM
MIU32936Medicare UPIN
MIOF35357Medicare ID - Type Unspecified