Provider Demographics
NPI:1790942282
Name:HOLLIDAY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:HOLLIDAY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-929-8766
Mailing Address - Street 1:500 CIRCLE DR
Mailing Address - Street 2:A MANOWN PROFESSIONAL BUILDING
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-9680
Mailing Address - Country:US
Mailing Address - Phone:724-929-8766
Mailing Address - Fax:724-929-8767
Practice Address - Street 1:500 CIRCLE DR
Practice Address - Street 2:A MANOWN PROFESSIONAL BUILDING
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-9680
Practice Address - Country:US
Practice Address - Phone:724-929-8766
Practice Address - Fax:724-929-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003253L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA789620OtherHIGHMARK
PA5457054OtherAETNA
PA0013983480001Medicaid
PA425301Medicare UPIN