MEDICARE: DR. COLBY WELLS HOLLADAY DC

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	16397	AR

General Provider Information

NPI Number	:	1700566999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLBY WELLS HOLLADAY DC

Provider Business Mailing Address
First Line	:	1312 STONE ST
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-4522
Country	:	US
Telephone Number	:	870-530-2137
Fax Number	:

Provider Business Practice Location Address
First Line	:	1312 STONE ST
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-4522
Country	:	US
Telephone Number	:	870-530-2137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2023
Last Update Date	:	08/02/2023

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