MEDICARE: HOLLSTROM & ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34716	OTHER	FL	BLUE CROSS AND BLUE SHIEL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205906831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLSTROM & ASSOCIATES INC

Provider Business Mailing Address
First Line	:	11444 SEMINOLE BLVD
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33778-3237
Country	:	US
Telephone Number	:	727-393-6100
Fax Number	:	727-393-5461

Provider Business Practice Location Address
First Line	:	11444 SEMINOLE BLVD
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33778-3237
Country	:	US
Telephone Number	:	727-393-6100
Fax Number	:	727-393-5461

Authorized Official
Title or Position	:	CLINIC MANAGER
Name	:	MRS. KATHLEEN S HOLLSTROM
Credential	:	RN BSN
Telephone Number	:	727-393-6100

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/27/2007

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Directions to “HOLLSTROM & ASSOCIATES INC ” Practice Location

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