Active NPI
Charles Dane Hollis, LAC
- Acupuncturist
- Milwaukee, WI
National Provider Identifier
1023761483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 1041-55
- Practice address
- 4813 W National Ave
Milwaukee, WI 53214-3523 - Phone
- (414) 502-8235
- Fax
- (414) 921-9772
- NPI assigned
- Jan 26, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 1041-55 | WI | Primary |
Addresses
Primary practice location
4813 W National Ave
Milwaukee, WI 53214-3523
Mailing address
S30W30370 Sunset Dr
Waukesha, WI 53189-9007
Phone (229) 733-7980
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1041-55 | WI | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Veteran Sanctuary LLC | Acupuncturist | Current | Accepting new patients |
Locations
4813 W National Ave
Milwaukee, WI 53214
Phone (414) 502-8235
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Acupuncturist
- Milwaukee, WI
- NPI 1336854215
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1643155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681862400000",
"number": "1023761483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "S30W30370 SUNSET DR",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531899007",
"telephone_number": "229-733-7980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4813 W NATIONAL AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532143523",
"telephone_number": "414-502-8235",
"fax_number": "414-921-9772"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLIS",
"first_name": "CHARLES",
"middle_name": "DANE",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-01-26",
"last_updated": "2023-04-19",
"certification_date": "2023-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "WI",
"license": "1041-55",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.