Provider Demographics
NPI:1972673945
Name:HOLLAND, JOHN HASKELL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HASKELL
Last Name:HOLLAND
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 1:355 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5643
Mailing Address - Country:US
Mailing Address - Phone:562-694-8347
Mailing Address - Fax:
Practice Address - Street 1:355 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-5643
Practice Address - Country:US
Practice Address - Phone:562-694-8347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13060Medicare ID - Type Unspecified
CAU46977Medicare UPIN