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NPI Code Detail

MEDICARE: CARLY KIRBY, INC.

MEDICARE: CARLY KIRBY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center1182CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11265441885OTHERCOPERSONAL NPI

General Provider Information

NPI Number : 1578807889
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARLY KIRBY, INC.
Provider Business Mailing Address
First Line : 11720 MONTGOMERY CIR
Second Line :
City : LONGMONT
State : CO
Zip : 80504-5209
Country : US
Telephone Number : 720-301-9705
Fax Number :
Provider Business Practice Location Address
First Line : 1551 PROFESSIONAL LN UNIT 220
Second Line :
City : LONGMONT
State : CO
Zip : 80501-6964
Country : US
Telephone Number : 303-772-9660
Fax Number : 303-772-9259
Authorized Official
Title or Position : OWNER
Name : CARLY KIRBY
Credential : DIPL. OF OM, LAC.
Telephone Number : 720-301-9705
Provider Enumeration Date : 11/27/2012
Last Update Date : 11/27/2012

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