Provider Demographics
NPI:1922312966
Name:TERRY F HOLLAND PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:TERRY F HOLLAND PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-223-2307
Mailing Address - Street 1:14 BRYSON DR
Mailing Address - Street 2:
Mailing Address - City:SUTTER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95685-4118
Mailing Address - Country:US
Mailing Address - Phone:209-223-2307
Mailing Address - Fax:209-267-5565
Practice Address - Street 1:14 BRYSON DR
Practice Address - Street 2:
Practice Address - City:SUTTER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95685-4118
Practice Address - Country:US
Practice Address - Phone:209-223-2307
Practice Address - Fax:209-267-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 12707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATO4866Medicare UPIN
CADC0127070Medicare PIN