Provider Demographics
NPI:1568518397
Name:HOLLIDAY, ROBERT TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TODD
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 1:38 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PELZER
Mailing Address - State:SC
Mailing Address - Zip Code:29669-1514
Mailing Address - Country:US
Mailing Address - Phone:864-947-9999
Mailing Address - Fax:864-947-7777
Practice Address - Street 1:38 MAIN ST
Practice Address - Street 2:
Practice Address - City:PELZER
Practice Address - State:SC
Practice Address - Zip Code:29669-1514
Practice Address - Country:US
Practice Address - Phone:864-947-9999
Practice Address - Fax:864-947-7777
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2392111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU78686Medicare UPIN
SCAA06980281Medicare ID - Type Unspecified