Provider Demographics
NPI:1194900951
Name:HOLICK HOLISTIC CHIROPRATIC CENTER
Entity type:Organization
Organization Name:HOLICK HOLISTIC CHIROPRATIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-352-8051
Mailing Address - Street 1:116 OGLETHORPE PROF. COURT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4730
Mailing Address - Country:US
Mailing Address - Phone:912-352-8051
Mailing Address - Fax:912-352-8076
Practice Address - Street 1:116 OGLETHORPE PROF. CT
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-352-8051
Practice Address - Fax:912-352-8076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-29
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP399Medicare PIN