Provider Demographics
NPI:1811080732
Name:HOLICK, COLLEEN ANNE (DC)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANNE
Last Name:HOLICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:FERENC-HOLICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:102 OGLETHORPE PROFESSIONAL CT STE 6
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3632
Mailing Address - Country:US
Mailing Address - Phone:912-352-8051
Mailing Address - Fax:912-352-8076
Practice Address - Street 1:102 OGLETHORPE PROFESSIONAL CT STE 6
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3632
Practice Address - Country:US
Practice Address - Phone:912-352-8051
Practice Address - Fax:912-352-8076
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U41704Medicare UPIN
35ZCCGHMedicare ID - Type Unspecified