Provider Demographics
NPI:1942838255
Name:WILLISON, HOLLY NICHOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:NICHOLE
Last Name:WILLISON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:NICHOLE
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2250 S MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2506
Mailing Address - Country:US
Mailing Address - Phone:800-595-2447
Mailing Address - Fax:
Practice Address - Street 1:2250 S MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2506
Practice Address - Country:US
Practice Address - Phone:800-595-2447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor