Provider Demographics
NPI:1316966831
Name:HOLLADAY, MELODY A (DC, BCNP)
Entity type:Individual
Prefix:DR
First Name:MELODY
Middle Name:A
Last Name:HOLLADAY
Suffix:
Gender:F
Credentials:DC, BCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 JORDAN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-4166
Mailing Address - Country:US
Mailing Address - Phone:928-203-9060
Mailing Address - Fax:928-204-0039
Practice Address - Street 1:450 JORDAN RD
Practice Address - Street 2:SUITE A
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4166
Practice Address - Country:US
Practice Address - Phone:928-203-9060
Practice Address - Fax:928-204-0039
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5883111NI0900X, 111NN0400X, 111NN1001X, 111NR0200X, 111NS0005X, 111NT0100X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NI0900XChiropractic ProvidersChiropractorInternist
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Not Answered111NR0200XChiropractic ProvidersChiropractorRadiology
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NT0100XChiropractic ProvidersChiropractorThermography
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0941490Medicare UPIN