Provider Demographics
NPI:1457101586
Name:VERKUILEN, CARLY (LAC, DIPL AC)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:VERKUILEN
Suffix:
Gender:F
Credentials:LAC, DIPL AC
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:VERKUILEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, DIPL AC, MAC
Mailing Address - Street 1:9227 E LINCOLN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5504
Mailing Address - Country:US
Mailing Address - Phone:303-470-1995
Mailing Address - Fax:
Practice Address - Street 1:9227 E LINCOLN AVE STE 300
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5504
Practice Address - Country:US
Practice Address - Phone:313-701-9504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002861171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist