Provider Demographics
NPI:1366658924
Name:SHACKELTON, MARY F (ND)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:SHACKELTON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 VALMONT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1361
Mailing Address - Country:US
Mailing Address - Phone:303-449-3777
Mailing Address - Fax:303-449-3775
Practice Address - Street 1:2975 VALMONT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1361
Practice Address - Country:US
Practice Address - Phone:303-449-3777
Practice Address - Fax:303-449-3775
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT099-0000061175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath