Provider Demographics
NPI:1851935985
Name:RADIG, HOLLIE LYNN (DC)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:LYNN
Last Name:RADIG
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 1:14205 AURORA AVE
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2687
Mailing Address - Country:US
Mailing Address - Phone:515-422-4979
Mailing Address - Fax:
Practice Address - Street 1:9400 PLUM DR STE 140
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-6242
Practice Address - Country:US
Practice Address - Phone:515-422-4979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor