Healthcare Provider Details

I. General information

NPI: 1700424470
Provider Name (Legal Business Name): GREGORY J CARROLL L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 S JACKSON ST STE 320
DENVER CO
80210-3803
US

IV. Provider business mailing address

1200 S ONEIDA ST APT 10-205
DENVER CO
80224-3161
US

V. Phone/Fax

Practice location:
  • Phone: 720-325-8182
  • Fax:
Mailing address:
  • Phone: 702-325-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number163544
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: