Provider Demographics
NPI:1396023222
Name:HOLLYWOOD WELLNESS ASSOCIATES, INC.
Entity Type:Organization
Organization Name:HOLLYWOOD WELLNESS ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:EMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-881-5430
Mailing Address - Street 1:5568 S FORT APACHE RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-3602
Mailing Address - Country:US
Mailing Address - Phone:623-399-8606
Mailing Address - Fax:623-399-9958
Practice Address - Street 1:5568 S FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-3602
Practice Address - Country:US
Practice Address - Phone:623-399-8606
Practice Address - Fax:623-399-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVB01408OtherLICENSE #