=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689913303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA A HOLZHEI L.AC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2013
-----------------------------------------------------
Last Update Date | 02/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 E LAKE ST SUITE 630
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60601-5959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-259-1544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4623 N HAMILTON AVE FIRST FLOOR
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60625-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-259-1544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 198001001
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------