MEDICARE: GREGORY GOLDEN L.AC

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
1	171100000X	Acupuncturist	84000143A	IN

General Provider Information

NPI Number	:	1588085229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY GOLDEN L.AC

Provider Business Mailing Address
First Line	:	210 E 91ST ST
Second Line	:	SUITE B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1569
Country	:	US
Telephone Number	:	317-832-9434
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 E 91ST ST
Second Line	:	SUITE B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1569
Country	:	US
Telephone Number	:	317-832-9434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2013
Last Update Date	:	12/24/2013

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Directions to “ GREGORY GOLDEN L.AC” Practice Location

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