Provider Demographics
NPI:1841364502
Name:FINK, HOLLY RENAE (DC)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:RENAE
Last Name:FINK
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 1:335 HALF 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-2978
Mailing Address - Country:US
Mailing Address - Phone:601-736-5031
Mailing Address - Fax:601-736-5031
Practice Address - Street 1:335 HALF 2ND STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2978
Practice Address - Country:US
Practice Address - Phone:601-736-5031
Practice Address - Fax:601-736-5031
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS350000075Medicare ID - Type Unspecified
640817527Medicare UPIN