Provider Demographics
NPI:1255400917
Name:HOLLIDAY, GLEN E (DC)
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:E
Last Name:HOLLIDAY
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 1:500 CIRCLE DR
Mailing Address - Street 2:A MANOWN PROFESSIONAL BUILDING
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-9680
Mailing Address - Country:US
Mailing Address - Phone:724-929-8766
Mailing Address - Fax:724-929-8767
Practice Address - Street 1:500 CIRCLE DR
Practice Address - Street 2:A MANOWN PROFESSIONAL BUILDING
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-9680
Practice Address - Country:US
Practice Address - Phone:724-929-8766
Practice Address - Fax:724-929-8767
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003253L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA329874OtherHEALTH AMERICA HEALTH ASS
PA5457054OtherAETNA
PA01398348Medicaid
PA103337OtherUPMC HEALTH PLAN
PA9082268OtherCIGNA
PA789620OtherHIGHMARK
PA9082268OtherCIGNA
PA425301Medicare ID - Type Unspecified