Provider Demographics
NPI:1992767743
Name:SHIM, GREG (LAC, DIPLOM)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:SHIM
Suffix:
Gender:M
Credentials:LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OAKWOOD PARK PLZ
Mailing Address - Street 2:SUITE #106
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1882
Mailing Address - Country:US
Mailing Address - Phone:303-660-4357
Mailing Address - Fax:303-660-4351
Practice Address - Street 1:1 OAKWOOD PARK PLZ
Practice Address - Street 2:SUITE #106
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1882
Practice Address - Country:US
Practice Address - Phone:303-660-4357
Practice Address - Fax:303-660-4351
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU-1007171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist