Provider Demographics
NPI:1609872936
Name:HOLLADAY, MONICA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:LYNN
Last Name:HOLLADAY
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:TX
Mailing Address - Zip Code:75831-0749
Mailing Address - Country:US
Mailing Address - Phone:903-322-2166
Mailing Address - Fax:903-322-1667
Practice Address - Street 1:713 HWY 79 W
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:TX
Practice Address - Zip Code:75831
Practice Address - Country:US
Practice Address - Phone:903-322-2166
Practice Address - Fax:903-322-1667
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605844OtherBLUE SHIELD OF TEXAS
TXU70073Medicare UPIN
TX609066Medicare PIN