Provider Demographics
NPI:1447721048
Name:POTTER, HOLLY A (DC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:POTTER
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 1:210 PHOENIX MILLS PLZ
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2005 LYELL AVE STE 115
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-2325
Practice Address - Country:US
Practice Address - Phone:585-458-2679
Practice Address - Fax:585-219-5660
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor