Provider Demographics
NPI:1801082953
Name:JAMES E. HOLLINGSWORTH, D.C., CHTD.
Entity type:Organization
Organization Name:JAMES E. HOLLINGSWORTH, D.C., CHTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-375-4415
Mailing Address - Street 1:10451 W GARVERDALE CT
Mailing Address - Street 2:STE. 203
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5408
Mailing Address - Country:US
Mailing Address - Phone:208-375-4415
Mailing Address - Fax:208-375-4419
Practice Address - Street 1:10451 W GARVERDALE CT
Practice Address - Street 2:STE. 203
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5408
Practice Address - Country:US
Practice Address - Phone:208-375-4415
Practice Address - Fax:208-375-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-22
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDT44488Medicare UPIN
ID1671799Medicare PIN