Provider Demographics
NPI:1942538624
Name:KARRAKER, GREGORY R (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:R
Last Name:KARRAKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11152 HURON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4321
Mailing Address - Country:US
Mailing Address - Phone:303-457-4928
Mailing Address - Fax:303-457-1816
Practice Address - Street 1:11152 HURON ST STE 102
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4321
Practice Address - Country:US
Practice Address - Phone:303-457-4928
Practice Address - Fax:303-457-1816
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor