Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 28089 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 28089 | CA |
NPI | 1295994101 |
---|---|
Provider Name | Dr. Corey Arthur Hollis |
First Address | Irvine, CA 92614-6322 |
Second Address | Irvine, CA 92614-6322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 15/06/2012 |