Provider Demographics
NPI:1134403066
Name:HOLT, MICHAEL D (LAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:HOLT
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 1:304 UPTOWN SQ
Mailing Address - Street 2:SUITE A
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0583
Mailing Address - Country:US
Mailing Address - Phone:615-890-6996
Mailing Address - Fax:
Practice Address - Street 1:304 UPTOWN SQ
Practice Address - Street 2:SUITE A
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0583
Practice Address - Country:US
Practice Address - Phone:615-890-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN193171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist