Provider Demographics
NPI:1649468893
Name:HOLLY CHIROPRACTIC ASSOCIATES, P.C.
Entity type:Organization
Organization Name:HOLLY CHIROPRACTIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-265-8100
Mailing Address - Street 1:1852 BURLINGTON MOUNT HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1070
Mailing Address - Country:US
Mailing Address - Phone:609-265-8100
Mailing Address - Fax:609-265-8369
Practice Address - Street 1:1852 BURLINGTON MOUNT HOLLY RD
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-1070
Practice Address - Country:US
Practice Address - Phone:609-265-8100
Practice Address - Fax:609-265-8369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00391500111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ806872OtherAETNA
NJMA483029OtherMEDICARE ID
NJ1172680OtherHORIZON
NJ1172680OtherHORIZON