Provider Demographics
NPI:1922063890
Name:HOLLAND, LISA ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
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 1:10148 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6760
Mailing Address - Country:US
Mailing Address - Phone:804-747-7474
Mailing Address - Fax:804-965-9360
Practice Address - Street 1:10148 W BROAD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6760
Practice Address - Country:US
Practice Address - Phone:804-747-7474
Practice Address - Fax:804-965-9360
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA257776OtherANTHEM
VAU69688Medicare UPIN