Provider Demographics
NPI:1629024203
Name:HOLLINGSWORTH, JAMES LLOYD (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LLOYD
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:J.
Other - Middle Name:LLOYD
Other - Last Name:HOLLINGSWORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:52 PALCICH RD
Mailing Address - Street 2:PO BOX 1731
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635-9602
Mailing Address - Country:US
Mailing Address - Phone:231-352-4447
Mailing Address - Fax:231-325-2279
Practice Address - Street 1:52 PALCICH RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-9602
Practice Address - Country:US
Practice Address - Phone:231-352-4447
Practice Address - Fax:231-325-2279
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4742357Medicaid
MIN12960005Medicare ID - Type Unspecified
MIV04175Medicare UPIN