Provider Demographics
NPI:1659454502
Name:HOLLOWAY, GLOVER DWAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:GLOVER
Middle Name:DWAINE
Last Name:HOLLOWAY
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 1:1761 OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1017
Mailing Address - Country:US
Mailing Address - Phone:303-861-1774
Mailing Address - Fax:303-861-0606
Practice Address - Street 1:1761 OGDEN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1017
Practice Address - Country:US
Practice Address - Phone:303-861-1774
Practice Address - Fax:303-861-0606
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU71714Medicare UPIN
COC802467Medicare PIN