Provider Demographics
NPI:1083746614
Name:GOLD, SHANE ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:ALAN
Last Name:GOLD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 S HOLLY CIR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1019
Mailing Address - Country:US
Mailing Address - Phone:303-798-2000
Mailing Address - Fax:
Practice Address - Street 1:7061 S UNIVERSITY BLVD STE 9
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1543
Practice Address - Country:US
Practice Address - Phone:303-798-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4592111N00000X, 111NR0400X, 171100000X, 225700000X, 225000000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC487928Medicare PIN
COU75105Medicare UPIN