Provider Demographics
NPI:1437101425
Name:HOLM, LEWIS M (DC LAC)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:M
Last Name:HOLM
Suffix:
Gender:M
Credentials:DC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SNELLING AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1944
Mailing Address - Country:US
Mailing Address - Phone:651-219-4114
Mailing Address - Fax:651-560-7009
Practice Address - Street 1:232 SNELLING AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1944
Practice Address - Country:US
Practice Address - Phone:651-219-4114
Practice Address - Fax:651-560-7009
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3206111N00000X
CO721171100000X
MN5575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28793Medicare ID - Type Unspecified
MNH300217791Medicare PIN