Organization
CHIRO ALLIANCE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHLEEN S HOLLSTROM RN, BSN (PRESIDENT)
(727) 319-2434
Entity
Organization
Contact information
Practice address
10706 115TH AVE, LARGO, FL 33778-3221
(727) 319-6199
(727) 395-0071
Mailing address
PO BOX 3340, SEMINOLE, FL 33775-3340
(727) 319-6199
(727) 395-0071
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21563
BLUE CROSS AND BLUE SHIEL
FL
Enumeration date
02/07/2006
Last updated
08/22/2020
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