Provider Demographics
NPI:1417130428
Name:HOLLAND, JOHN DIAMOND IV (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DIAMOND
Last Name:HOLLAND
Suffix:IV
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6315
Mailing Address - Country:US
Mailing Address - Phone:562-322-6533
Mailing Address - Fax:562-594-6009
Practice Address - Street 1:911 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6315
Practice Address - Country:US
Practice Address - Phone:562-322-6533
Practice Address - Fax:562-594-6009
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor