Provider Demographics
NPI:1750893764
Name:O'NEAL, HOLLIE (DC)
Entity type:Individual
Prefix:DR
First Name:HOLLIE
Middle Name:
Last Name:O'NEAL
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 1:2535 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 203 BOX #139
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118
Mailing Address - Country:US
Mailing Address - Phone:318-828-1564
Mailing Address - Fax:
Practice Address - Street 1:635 BERT KOUNS INDUSTRIAL LOOP STE 400
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-5704
Practice Address - Country:US
Practice Address - Phone:318-828-1564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009957111N00000X
LA1958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor