Provider Demographics
NPI:1124228507
Name:HOLLOWAY, LORI DENISE (DC)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:DENISE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845
Mailing Address - Country:US
Mailing Address - Phone:607-796-2150
Mailing Address - Fax:607-562-8426
Practice Address - Street 1:301 W. BORAD ST
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845
Practice Address - Country:US
Practice Address - Phone:607-796-2150
Practice Address - Fax:607-562-8426
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor