Healthcare Provider Details

I. General information

NPI: 1164556049
Provider Name (Legal Business Name): LEWIS P HOLSTON L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 WHITE AVE.
WINTHROP WA
98862-0862
US

IV. Provider business mailing address

PO BOX 862
WINTHROP WA
98862-0862
US

V. Phone/Fax

Practice location:
  • Phone: 509-996-8194
  • Fax:
Mailing address:
  • Phone: 509-996-8194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC529
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: