Provider Demographics
NPI:1376636761
Name:HOLLAND, WILLIAM AUGUSTINE (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:AUGUSTINE
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 1:711 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1036
Mailing Address - Country:US
Mailing Address - Phone:585-798-5116
Mailing Address - Fax:585-798-5159
Practice Address - Street 1:302 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3415
Practice Address - Country:US
Practice Address - Phone:585-798-5116
Practice Address - Fax:585-798-5159
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008934-0111N00000X
FLCH12486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02167971Medicaid
NY161552265OtherTAX ID
NYBB1236Medicare PIN
NYU70981Medicare UPIN