Provider Demographics
NPI:1992923163
Name:HOLLAND, BRENDA MARY (DC)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:MARY
Last Name:HOLLAND
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:W164N11269 SQUIRE DR STE B
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6017
Mailing Address - Country:US
Mailing Address - Phone:262-250-1948
Mailing Address - Fax:
Practice Address - Street 1:W164N11269 SQUIRE DR STE B
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6017
Practice Address - Country:US
Practice Address - Phone:262-250-1948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4044012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000167023Medicare PIN