=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992179329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLOITY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2015
-----------------------------------------------------
Last Update Date | 11/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 287 W JOHNSTOWN RD
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-2732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-499-4717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 287 W JOHNSTOWN RD
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-2732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-499-4717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JEFFREY A BROWN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 614-499-4717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3485
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------