Provider Demographics
NPI:1588085229
Name:GOLDEN, GREGORY (LAC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 91ST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1569
Mailing Address - Country:US
Mailing Address - Phone:317-832-9434
Mailing Address - Fax:
Practice Address - Street 1:210 E 91ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1569
Practice Address - Country:US
Practice Address - Phone:317-832-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-24
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000143A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist