Chanelle R Holliday, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3715 Issued in WI

Practice address

126 S 2ND St
Black River Falls, WI 54615-1726

Phone

(715) 284-2915

Fax

(715) 284-7492

NPI assigned

Jul 28, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2000

Medicare assignment

May accept Medicare assignment

Group practices

Black River Chiropractic Clinic SC 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Black River Chiropractic Clinic, SC

  • Chiropractor
  • Black River Falls, WI
  • NPI 1689747826
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629078902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 S 2ND ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546151726",
            "telephone_number": "715-284-2915",
            "fax_number": "715-284-7492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 S 2ND ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546151726",
            "telephone_number": "715-284-2915",
            "fax_number": "715-284-7492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLIDAY",
        "first_name": "CHANELLE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "205747937017",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38929100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ho Chunk Nation
• Ho-Chunk Health Care Center
• Ho-Chunk Nation
• Ho-Chunk Nation
• Ho-Chunk Nation
• Cathleen L Holm, MA, LMFT
• Roberta L Holman, MS, CADC
• Lynn L Hoornstra, MS, LPC
• Kirk Lawrence Hopinka, APNP
• Todd W Intihar, PT

• All providers in Black River Falls, WI
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.