Healthcare Provider Details

I. General information

NPI: 1407229701
Provider Name (Legal Business Name): ANTHONY PAUL GURULE JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 CIMARRON DR STE 201
LAFAYETTE CO
80026-1283
US

IV. Provider business mailing address

1817 CO-42, SUITE A
LOUISVILLE CO
80027
US

V. Phone/Fax

Practice location:
  • Phone: 303-717-6323
  • Fax:
Mailing address:
  • Phone: 303-717-6323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHR.0007332
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: