Provider Demographics
NPI:1720173479
Name:HOLLEY, NATALIE A (DC)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:A
Last Name:HOLLEY
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 69
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-0069
Mailing Address - Country:US
Mailing Address - Phone:903-537-2263
Mailing Address - Fax:
Practice Address - Street 1:110 DALLAS ST W
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-2336
Practice Address - Country:US
Practice Address - Phone:903-537-2263
Practice Address - Fax:903-537-2338
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC06035627Medicaid
TXC06035627Medicaid
U02276Medicare UPIN