Provider Demographics
NPI:1992218606
Name:SHINDOLL, JOSEPH (MT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SHINDOLL
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1012
Mailing Address - Country:US
Mailing Address - Phone:303-332-6275
Mailing Address - Fax:
Practice Address - Street 1:1776 S JACKSON ST STE 702
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3806
Practice Address - Country:US
Practice Address - Phone:303-332-6275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0006487225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist