Provider Demographics
NPI:1205906831
Name:HOLLSTROM & ASSOCIATES INC
Entity type:Organization
Organization Name:HOLLSTROM & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOLLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:727-393-6100
Mailing Address - Street 1:11444 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-3237
Mailing Address - Country:US
Mailing Address - Phone:727-393-6100
Mailing Address - Fax:727-393-5461
Practice Address - Street 1:11444 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-3237
Practice Address - Country:US
Practice Address - Phone:727-393-6100
Practice Address - Fax:727-393-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34716OtherBLUE CROSS AND BLUE SHIEL
FL382201000Medicaid
FL34716OtherBLUE CROSS AND BLUE SHIEL