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General NPI Number Information
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NPI Number | 1477830776
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Entity Type | Individual
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Provider Name | BRENT HOLLAND D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 05/24/2019
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Provider Practice Location Address
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Address Line | 1203 W BROADWAY ST
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City | ARDMORE
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State | OK
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Zip | 73401-2835
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Country | US
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Telephone | 580-490-9888
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Fax | 580-490-9888
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Provider Business Mailing Address
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Address Line | 1203 W BROADWAY ST
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City | ARDMORE
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State | OK
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Zip | 73401-2835
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Country | US
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Telephone | 580-490-9888
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Fax | 580-490-9888
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4052
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License Number State | OK
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