Healthcare Provider Details

I. General information

NPI: 1437669256
Provider Name (Legal Business Name): GREGORY HOLLIS L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date: 08/08/2018
Reactivation Date: 08/16/2023

III. Provider practice location address

50 S FEDERAL BLVD
DENVER CO
80219-2044
US

IV. Provider business mailing address

50 S FEDERAL BLVD
DENVER CO
80219-2044
US

V. Phone/Fax

Practice location:
  • Phone: 303-922-2977
  • Fax: 303-922-2044
Mailing address:
  • Phone: 303-922-2977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU.00022777
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: