Provider Demographics
NPI:1144935164
Name:KUSHNER, HOLLIE CARLENE (DC)
Entity type:Individual
Prefix:DR
First Name:HOLLIE
Middle Name:CARLENE
Last Name:KUSHNER
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 1:7404 RIVER VISTA ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5450
Mailing Address - Country:US
Mailing Address - Phone:321-261-1336
Mailing Address - Fax:
Practice Address - Street 1:7404 RIVER VISTA ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5450
Practice Address - Country:US
Practice Address - Phone:321-261-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty