Healthcare Provider Details

I. General information

NPI: 1568518397
Provider Name (Legal Business Name): ROBERT TODD HOLLIDAY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 MAIN ST
PELZER SC
29669-1514
US

IV. Provider business mailing address

38 MAIN ST
PELZER SC
29669-1514
US

V. Phone/Fax

Practice location:
  • Phone: 864-947-9999
  • Fax: 864-947-7777
Mailing address:
  • Phone: 864-947-9999
  • Fax: 864-947-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2392
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: