Provider Demographics
NPI:1932256054
Name:HOLLOWAY, ISAAC (DN)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 SOMERSET LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-1247
Mailing Address - Country:US
Mailing Address - Phone:847-584-3930
Mailing Address - Fax:
Practice Address - Street 1:1408 SOMERSET LN
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-1247
Practice Address - Country:US
Practice Address - Phone:847-584-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001633664OtherBCBS PROVIDER NUMBER