=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992994420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUVLIGHT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2007
-----------------------------------------------------
Last Update Date | 03/31/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 SOUTH PINE STREET
-----------------------------------------------------
City | TELLURIDE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81435-2461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-728-1442
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2461
-----------------------------------------------------
City | TELLURIDE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81435-2461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-728-1442
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JOHN A HOLT JR.
-----------------------------------------------------
Credential | L.AC., DIPL.OM, LMT
-----------------------------------------------------
Telephone | 970-728-1442
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 1268
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------