MEDICARE: MR. DARREN WAYNE HOLMAN L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	323	NC

General Provider Information

NPI Number	:	1538572110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARREN WAYNE HOLMAN L.AC

Provider Business Mailing Address
First Line	:	3200 GULFSTREAM CT
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-7437
Country	:	US
Telephone Number	:	704-942-5300
Fax Number	:	704-684-6091

Provider Business Practice Location Address
First Line	:	2910 OLD MONROE RD
Second Line	:	SUITE D
City	:	STALLINGS
State	:	NC
Zip	:	28104-5010
Country	:	US
Telephone Number	:	704-942-5300
Fax Number	:	704-684-6091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	06/11/2014

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