David Lee Holliday, D.C.
Individual provider Active NPI Chiropractor · Kendallville, IN
NPI 1467469858 · NPPES record last updated Mar 6, 2024
Key facts
- NPI
- 1467469858
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 08001453 (IN)
- Practice address
- 511 Professional Way
Kendallville, IN 46755-2928 - Phone
- (260) 347-8177
- Fax
- (260) 347-8171
- NPI assigned
- Aug 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100313000062 | IN | Practitioner - Chiropractic | 2466587613 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08001453 | IN | MD | Chiropractor |
| 08001453A | IN | MD | Sports Physician Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holliday Chiropractic Care, LLC | Chiropractor | Current |
Accepting new patients |
Locations
511 Professional Way
Kendallville, IN 46755
Phone (260) 347-8177
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 08001453A | IN | |
| Chiropractor | 111N00000X | 08001453 | IN | Yes |
Addresses
Primary practice location
511 Professional Way
Kendallville, IN 46755-2928
Mailing address
511 Professional Way
Kendallville, IN 46755-2928
Phone (260) 347-8177
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100191030 | Medicaid | IN |
Other providers in Kendallville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.