Provider Demographics
NPI:1265718381
Name:MANTEUFFEL, KARL (LAC)
Entity type:Individual
Prefix:MR
First Name:KARL
Middle Name:
Last Name:MANTEUFFEL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4395 BUTLER CIR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6649
Mailing Address - Country:US
Mailing Address - Phone:303-847-2830
Mailing Address - Fax:
Practice Address - Street 1:1140 US HIGHWAY 287 UNIT 100
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7076
Practice Address - Country:US
Practice Address - Phone:303-469-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1734171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist