Healthcare Provider Details

I. General information

NPI: 1588085229
Provider Name (Legal Business Name): GREGORY GOLDEN L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2013
Last Update Date: 12/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 91ST ST SUITE B
INDIANAPOLIS IN
46240-1569
US

IV. Provider business mailing address

210 E 91ST ST SUITE B
INDIANAPOLIS IN
46240-1569
US

V. Phone/Fax

Practice location:
  • Phone: 317-832-9434
  • Fax:
Mailing address:
  • Phone: 317-832-9434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number84000143A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: