Provider Demographics
NPI:1407450521
Name:THARP, HOLLY MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MICHELLE
Last Name:THARP
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:THARP
Other - Last Name:LUNDGREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2003 SOUTHERN BLVD SE STE 109
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3752
Mailing Address - Country:US
Mailing Address - Phone:505-892-2222
Mailing Address - Fax:
Practice Address - Street 1:2003 SOUTHERN BLVD SE STE 109
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3752
Practice Address - Country:US
Practice Address - Phone:505-892-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDC2254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor