Provider Demographics
NPI:1851990519
Name:MANSKE, SHAWN (ND)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:MANSKE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19767 E PIKES PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7400
Mailing Address - Country:US
Mailing Address - Phone:303-841-7121
Mailing Address - Fax:
Practice Address - Street 1:19767 E PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7400
Practice Address - Country:US
Practice Address - Phone:303-841-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000125175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath