Healthcare Provider Details

I. General information

NPI: 1063700292
Provider Name (Legal Business Name): HOLLIS FAMILY CHIROPRACTIC CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MARKET PLACE
HOLLIS NH
03049
US

IV. Provider business mailing address

PO BOX 1585
HOLLIS NH
03049-1585
US

V. Phone/Fax

Practice location:
  • Phone: 603-465-2235
  • Fax:
Mailing address:
  • Phone: 603-465-2235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number880
License Number StateNH

VIII. Authorized Official

Name: MORGAN OPTIONAL MACBEAN
Title or Position: MANAGING MEMBER
Credential: DC
Phone: 603-465-2235