Provider Demographics
NPI:1316291321
Name:GILL, KYLE PAUL (MSOM, LAC)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:PAUL
Last Name:GILL
Suffix:
Gender:M
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10722 E ILIFF AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4707
Mailing Address - Country:US
Mailing Address - Phone:720-329-0408
Mailing Address - Fax:
Practice Address - Street 1:10722 E ILIFF AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4707
Practice Address - Country:US
Practice Address - Phone:720-329-0408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO884171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist