Provider Demographics
NPI:1841248663
Name:HOLLERN, JAMES M (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:HOLLERN
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 1:9716 GRANDIN WOODS RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2378
Mailing Address - Country:US
Mailing Address - Phone:502-552-5906
Mailing Address - Fax:
Practice Address - Street 1:5215 NEW CUT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-3511
Practice Address - Country:US
Practice Address - Phone:502-552-5906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYF92627Medicare UPIN
KY6070102Medicare ID - Type Unspecified