Provider Demographics
NPI:1811056815
Name:HOLLOWAY, STEVEN WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WAYNE
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 CENTRAL AVE NE
Mailing Address - Street 2:LOT 1527
Mailing Address - City:HILLTOP
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2482
Mailing Address - Country:US
Mailing Address - Phone:763-571-7520
Mailing Address - Fax:
Practice Address - Street 1:4550 CENTRAL AVE NE
Practice Address - Street 2:LOT 1527
Practice Address - City:HILLTOP
Practice Address - State:MN
Practice Address - Zip Code:55421-2482
Practice Address - Country:US
Practice Address - Phone:763-571-7520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4181111N00000X
IAA06009111N00000X
WI3370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN003261OtherPROVIDER #