Provider Demographics
NPI:1295801884
Name:KREAGER, MANDY M (DC)
Entity type:Individual
Prefix:DR
First Name:MANDY
Middle Name:M
Last Name:KREAGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MAIN ST
Mailing Address - Street 2:UNIT G
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5046
Mailing Address - Country:US
Mailing Address - Phone:970-686-0920
Mailing Address - Fax:970-686-0953
Practice Address - Street 1:220 MAIN ST
Practice Address - Street 2:UNIT G
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5046
Practice Address - Country:US
Practice Address - Phone:970-686-0920
Practice Address - Fax:970-686-0953
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO450958Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
COF5803Medicare ID - Type UnspecifiedMEDICARE GROUP #