Jack Dee Hollada, D.C.
Individual provider Active NPI Chiropractor · Virginia, IL
NPI 1336148451 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1336148451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038-004567 (IL)
- Practice address
- 200 E Beardstown St
Virginia, IL 62691-1304 - Phone
- (217) 452-7252
- NPI assigned
- Jul 20, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH4004 | FL | MD | Chiropractor |
| 038-004567 | IL | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038-004567 | IL | Yes |
| Chiropractor | 111N00000X | CH4004 | FL |
Addresses
Primary practice location
200 E Beardstown St
Virginia, IL 62691-1304
Mailing address
200 E Beardstown St
Virginia, IL 62691-1304
Phone (217) 452-7252
Other providers in Virginia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.