Healthcare Provider Details

I. General information

NPI: 1003028663
Provider Name (Legal Business Name): MICHAEL R HOLLERBACH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date: 01/04/2018
Reactivation Date: 02/27/2018

III. Provider practice location address

10345 WATERVILLE ST
WHITEHOUSE OH
43571-9176
US

IV. Provider business mailing address

10345 WATERVILLE ST
WHITEHOUSE OH
43571-9176
US

V. Phone/Fax

Practice location:
  • Phone: 419-419-3800
  • Fax: 419-830-4020
Mailing address:
  • Phone: 419-419-3800
  • Fax: 419-830-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC04784
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: