Provider Demographics
NPI:1699790774
Name:REGEN, HOLLY M (DC)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:M
Last Name:REGEN
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:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-8022
Mailing Address - Country:US
Mailing Address - Phone:847-455-2222
Mailing Address - Fax:847-455-0788
Practice Address - Street 1:9620 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-3377
Practice Address - Country:US
Practice Address - Phone:847-455-2225
Practice Address - Fax:847-455-0788
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0038-005998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL526610Medicare ID - Type Unspecified
ILU19943Medicare UPIN