Healthcare Provider Details

I. General information

NPI: 1821219742
Provider Name (Legal Business Name): CAROL F KUTCHUKIAN-BOXLEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 REDWING RD STE 295
FORT COLLINS CO
80526-6316
US

IV. Provider business mailing address

2629 REDWING RD STE 295
FORT COLLINS CO
80526-6316
US

V. Phone/Fax

Practice location:
  • Phone: 970-690-2042
  • Fax: 970-372-1519
Mailing address:
  • Phone: 970-690-2042
  • Fax: 970-372-1519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1848
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: