Provider Demographics
NPI:1699395855
Name:HOLLOWAY, GEOFFREY (DC)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
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 1:15735 W US HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-6475
Mailing Address - Country:US
Mailing Address - Phone:715-934-0710
Mailing Address - Fax:715-598-4881
Practice Address - Street 1:1435 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-3918
Practice Address - Country:US
Practice Address - Phone:888-834-4551
Practice Address - Fax:715-598-4881
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010928111N00000X
WI6011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor