Provider Demographics
NPI:1467469858
Name:HOLLIDAY, DAVID LEE (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:HOLLIDAY
Suffix:
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 1:511 PROFESSIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-2928
Mailing Address - Country:US
Mailing Address - Phone:260-347-8177
Mailing Address - Fax:
Practice Address - Street 1:511 PROFESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2928
Practice Address - Country:US
Practice Address - Phone:260-347-8177
Practice Address - Fax:260-347-8171
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001453A111NS0005X
IN08001453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100191030Medicaid
IN100191030Medicaid
IN581440Medicare ID - Type Unspecified