Provider Demographics
NPI:1376728568
Name:YORK, HOLLY ELIZEBETH (DC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ELIZEBETH
Last Name:YORK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 BROADMOOR AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-1845
Mailing Address - Country:US
Mailing Address - Phone:616-575-9105
Mailing Address - Fax:616-575-9107
Practice Address - Street 1:3138 BROADMOOR AVE SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-1845
Practice Address - Country:US
Practice Address - Phone:616-575-9105
Practice Address - Fax:616-575-9107
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376728568OtherMEDICAID INDIVIDUAL ID
MI1922191048Medicaid
MI1376728568OtherMEDICAID INDIVIDUAL ID
MIP38330003Medicare PIN