Provider Demographics
NPI:1578807889
Name:CARLY KIRBY, INC.
Entity Type:Organization
Organization Name:CARLY KIRBY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:DIPL OF OM, LAC
Authorized Official - Phone:720-301-9705
Mailing Address - Street 1:11720 MONTGOMERY CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5209
Mailing Address - Country:US
Mailing Address - Phone:720-301-9705
Mailing Address - Fax:
Practice Address - Street 1:1551 PROFESSIONAL LN UNIT 220
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6964
Practice Address - Country:US
Practice Address - Phone:303-772-9660
Practice Address - Fax:303-772-9259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1182261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1265441885OtherPERSONAL NPI