Provider Demographics
NPI:1710872627
Name:HOLLAND SPINE AND SPORT LLC
Entity type:Organization
Organization Name:HOLLAND SPINE AND SPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-420-4590
Mailing Address - Street 1:4641 GULFSTARR DR STE 104
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-3776
Mailing Address - Country:US
Mailing Address - Phone:850-420-4590
Mailing Address - Fax:850-420-4590
Practice Address - Street 1:4641 GULFSTARR DR STE 104
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-3776
Practice Address - Country:US
Practice Address - Phone:850-420-4590
Practice Address - Fax:850-420-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty