Provider Demographics
NPI:1255491544
Name:HOLLERAN, PETER L (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:HOLLERAN
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 1:4340 REDWOOD HWY
Mailing Address - Street 2:F-103
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2121
Mailing Address - Country:US
Mailing Address - Phone:415-491-1822
Mailing Address - Fax:
Practice Address - Street 1:4340 REDWOOD HWY
Practice Address - Street 2:F-103
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2121
Practice Address - Country:US
Practice Address - Phone:415-491-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA015533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor