Provider Demographics
NPI:1407916687
Name:HOLLEY, JENNIFER RAE (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAE
Last Name:HOLLEY
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 1:1902 COMMON ST
Mailing Address - Street 2:SUITE 200-A
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3178
Mailing Address - Country:US
Mailing Address - Phone:830-643-0747
Mailing Address - Fax:830-643-1266
Practice Address - Street 1:1902 COMMON ST
Practice Address - Street 2:SUITE 200-A
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3178
Practice Address - Country:US
Practice Address - Phone:830-643-0747
Practice Address - Fax:830-643-1266
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor