Provider Demographics
NPI:1821641283
Name:HOLLAND, JESSICA RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RAE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHESAPEAKE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LYNDORA
Mailing Address - State:PA
Mailing Address - Zip Code:16045-1150
Mailing Address - Country:US
Mailing Address - Phone:172-482-2182
Mailing Address - Fax:
Practice Address - Street 1:6 CHESAPEAKE ST STE 205
Practice Address - Street 2:
Practice Address - City:LYNDORA
Practice Address - State:PA
Practice Address - Zip Code:16045-1150
Practice Address - Country:US
Practice Address - Phone:724-822-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013390111N00000X
PADC011693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty