Provider Demographics
NPI:1164556049
Name:HOLSTON, LEWIS P (LAC)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:P
Last Name:HOLSTON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 862
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:WA
Mailing Address - Zip Code:98862-0862
Mailing Address - Country:US
Mailing Address - Phone:509-996-8194
Mailing Address - Fax:
Practice Address - Street 1:202 WHITE AVE.
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:WA
Practice Address - Zip Code:98862-0862
Practice Address - Country:US
Practice Address - Phone:509-996-8194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC529171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist