Provider Demographics
NPI:1538767736
Name:CARDER, GREGORY (MAC, LAC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:CARDER
Suffix:
Gender:M
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 AKLEY RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7836
Mailing Address - Country:US
Mailing Address - Phone:802-451-6229
Mailing Address - Fax:
Practice Address - Street 1:809 SOUTH ST STE 311
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3585
Practice Address - Country:US
Practice Address - Phone:605-858-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0123957171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty