Provider Demographics
NPI:1952480246
Name:HOLLOWAY, WALTER CLYDE (DC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:CLYDE
Last Name:HOLLOWAY
Suffix:
Gender:M
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:PO BOX 380
Mailing Address - Street 2:1240 SCHOOL STREET
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697
Mailing Address - Country:US
Mailing Address - Phone:336-667-3323
Mailing Address - Fax:336-667-8718
Practice Address - Street 1:1240 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697
Practice Address - Country:US
Practice Address - Phone:336-667-3323
Practice Address - Fax:336-667-8718
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
04897OtherBCBS
04897OtherBCBS
NC244137Medicare ID - Type Unspecified