Provider Demographics
NPI:1407134869
Name:CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC CLINIC, LLC
Other - Org Name:DR MARK HOLLIMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-821-9312
Mailing Address - Street 1:PO BOX 382987
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-2987
Mailing Address - Country:US
Mailing Address - Phone:901-821-9312
Mailing Address - Fax:901-821-9317
Practice Address - Street 1:6520 QUINCE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8211
Practice Address - Country:US
Practice Address - Phone:901-821-9312
Practice Address - Fax:901-821-9317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty