Provider Demographics
NPI:1518269273
Name:HOLISTIC HEALTH CENTER LLC
Entity Type:Organization
Organization Name:HOLISTIC HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-720-3891
Mailing Address - Street 1:5084 VILLA LINDE PKWY
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3422
Mailing Address - Country:US
Mailing Address - Phone:810-720-3891
Mailing Address - Fax:810-720-3916
Practice Address - Street 1:5084 VILLA LINDE PKWY
Practice Address - Street 2:SUITE 7A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3422
Practice Address - Country:US
Practice Address - Phone:810-720-3891
Practice Address - Fax:810-720-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6559880001Medicare NSC