Provider Demographics
NPI:1427148949
Name:COLGAN, CHRISTY JOAN (LAC, MS)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:JOAN
Last Name:COLGAN
Suffix:
Gender:F
Credentials:LAC, MS
Other - Prefix:
Other - First Name:KIKI
Other - Middle Name:
Other - Last Name:COLGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, MS
Mailing Address - Street 1:247 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-5900
Mailing Address - Country:US
Mailing Address - Phone:802-864-2912
Mailing Address - Fax:
Practice Address - Street 1:875 ROOSEVELT HWY STE 220
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4460
Practice Address - Country:US
Practice Address - Phone:802-338-9356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091-0000146171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist