Healthcare Provider Details

I. General information

NPI: 1033357140
Provider Name (Legal Business Name): CHRIS ALLEN CARLISLE CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 S BROADWAY
LITTLETON CO
80122-2632
US

IV. Provider business mailing address

PO BOX 215
CASTLE ROCK CO
80104-0215
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-1339
  • Fax: 720-389-6158
Mailing address:
  • Phone: 303-814-1339
  • Fax: 720-389-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number96972
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: