Provider Demographics
NPI:1073053799
Name:BUNDY, SHANNON NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:NICOLE
Last Name:BUNDY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:NICOLE
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12050 PECOS ST STE 208
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2080
Mailing Address - Country:US
Mailing Address - Phone:720-379-7255
Mailing Address - Fax:720-524-3012
Practice Address - Street 1:12050 PECOS ST STE 208
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2080
Practice Address - Country:US
Practice Address - Phone:720-379-7255
Practice Address - Fax:720-524-3012
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor