Provider Demographics
NPI:1336461615
Name:HAPPY MANTAS WELLNESS TREE
Entity Type:Organization
Organization Name:HAPPY MANTAS WELLNESS TREE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-847-5519
Mailing Address - Street 1:1302 COLUMBINE ST
Mailing Address - Street 2:206
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2316
Mailing Address - Country:US
Mailing Address - Phone:303-847-5519
Mailing Address - Fax:
Practice Address - Street 1:720 S COLORADO BLVD
Practice Address - Street 2:STE162A
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-1904
Practice Address - Country:US
Practice Address - Phone:303-847-5519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty