Provider Demographics
NPI:1356439434
Name:HOLL, CARY L (DC)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:L
Last Name:HOLL
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 1:8013 L ST
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1734
Mailing Address - Country:US
Mailing Address - Phone:402-592-7686
Mailing Address - Fax:402-592-0689
Practice Address - Street 1:8013 L ST
Practice Address - Street 2:
Practice Address - City:RALSTON
Practice Address - State:NE
Practice Address - Zip Code:68127-1734
Practice Address - Country:US
Practice Address - Phone:402-592-7686
Practice Address - Fax:402-592-0689
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09735OtherBCBS
IA1517805Medicaid
NE47082043200Medicaid
NEP00204720OtherRR MEDICARE
NE47082043200Medicaid