Provider Demographics
NPI:1972597722
Name:HOLLETT, MARCIA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:ANN
Last Name:HOLLETT
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 1:3089 NW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-6722
Mailing Address - Country:US
Mailing Address - Phone:954-579-0180
Mailing Address - Fax:888-921-2667
Practice Address - Street 1:3313 GOLDA CIR
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-7153
Practice Address - Country:US
Practice Address - Phone:239-233-9898
Practice Address - Fax:888-921-2667
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 0005490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22373Medicare PIN
FLU12684Medicare UPIN