Provider Demographics
NPI:1437669256
Name:HOLLIS, GREGORY (LAC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-2044
Mailing Address - Country:US
Mailing Address - Phone:303-922-2977
Mailing Address - Fax:
Practice Address - Street 1:50 S FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-2044
Practice Address - Country:US
Practice Address - Phone:303-922-2977
Practice Address - Fax:303-922-2044
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2023-09-21
Deactivation Date:2018-08-08
Deactivation Code:
Reactivation Date:2023-08-16
Provider Licenses
StateLicense IDTaxonomies
COACU.00022777171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist