Provider Demographics
NPI:1447543541
Name:HOLLEY, NATHAN STEVEN (DC)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:STEVEN
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 NORTH WABASH STREET
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992
Mailing Address - Country:US
Mailing Address - Phone:260-563-8476
Mailing Address - Fax:260-563-8477
Practice Address - Street 1:508 NORTH WABASH STREET
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992
Practice Address - Country:US
Practice Address - Phone:260-563-8476
Practice Address - Fax:260-563-8477
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002581A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor