Active NPI
Gregory Vernon Hollstrom, DC
- Chiropractor
- Largo, FL
National Provider Identifier
1710988811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH002658
- Practice address
- 11444 Seminole Blvd
Largo, FL 33778-3237 - Phone
- (727) 393-6100
- Fax
- (727) 393-5461
- NPI assigned
- Aug 10, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH002658 | FL | Primary |
Addresses
Primary practice location
11444 Seminole Blvd
Largo, FL 33778-3237
Mailing address
11444 Seminole Blvd
Largo, FL 33778-3237
Phone (727) 393-6100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 051502700 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH002658 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282521600000",
"number": "1710988811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11444 SEMINOLE BLVD",
"city": "LARGO",
"state": "FL",
"postal_code": "337783237",
"telephone_number": "727-393-6100",
"fax_number": "727-393-5461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11444 SEMINOLE BLVD",
"city": "LARGO",
"state": "FL",
"postal_code": "337783237",
"telephone_number": "727-393-6100",
"fax_number": "727-393-5461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLSTROM",
"first_name": "GREGORY",
"middle_name": "VERNON",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-10",
"last_updated": "2010-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH002658",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "051502700",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Largo, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.