Provider Demographics
NPI:1023461795
Name:GREGORY W FUNK DC, PC
Entity type:Organization
Organization Name:GREGORY W FUNK DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-222-8048
Mailing Address - Street 1:4962 ASHBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-8840
Mailing Address - Country:US
Mailing Address - Phone:303-222-8048
Mailing Address - Fax:
Practice Address - Street 1:1615 CALIFORNIA ST
Practice Address - Street 2:SUITE 704
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-3705
Practice Address - Country:US
Practice Address - Phone:303-222-8048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4313261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center