Provider Demographics
NPI:1790758282
Name:CHIRO ALLIANCE CORPORATION
Entity Type:Organization
Organization Name:CHIRO ALLIANCE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOLLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:727-319-2434
Mailing Address - Street 1:PO BOX 3340
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33775-3340
Mailing Address - Country:US
Mailing Address - Phone:727-319-6199
Mailing Address - Fax:727-395-0071
Practice Address - Street 1:10706 115TH AVE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-3221
Practice Address - Country:US
Practice Address - Phone:727-319-6199
Practice Address - Fax:727-395-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21563OtherBLUE CROSS AND BLUE SHIEL