=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538572110
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARREN WAYNE HOLMAN L.AC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2014
-----------------------------------------------------
Last Update Date | 06/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2910 OLD MONROE RD SUITE D
-----------------------------------------------------
City | STALLINGS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28104-5010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-942-5300
-----------------------------------------------------
Fax | 704-684-6091
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3200 GULFSTREAM CT
-----------------------------------------------------
City | MATTHEWS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28105-7437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-942-5300
-----------------------------------------------------
Fax | 704-684-6091
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 323
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------