Provider Demographics
NPI:1265441885
Name:KIRBY, CARLY S (DIPL OM, LIC AC)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:S
Last Name:KIRBY
Suffix:
Gender:F
Credentials:DIPL OM, LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S MAIN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6462
Mailing Address - Country:US
Mailing Address - Phone:303-772-9660
Mailing Address - Fax:
Practice Address - Street 1:275 S MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6462
Practice Address - Country:US
Practice Address - Phone:303-772-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1182171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist