Provider Demographics
NPI:1639273121
Name:HOLISTIC SURGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:HOLISTIC SURGICAL ASSOCIATES, INC.
Other - Org Name:BACK PAIN SOLUTIONS OF NORTHWEST OHIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:F
Authorized Official - Last Name:LUCCHESE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-331-2225
Mailing Address - Street 1:545 W MARKET ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4717
Mailing Address - Country:US
Mailing Address - Phone:419-331-2225
Mailing Address - Fax:
Practice Address - Street 1:545 W MARKET ST
Practice Address - Street 2:SUITE 306
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4717
Practice Address - Country:US
Practice Address - Phone:419-331-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH203808853204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346387123OtherNP NPI
6268010001Medicare NSC