Provider Demographics
NPI:1457733362
Name:MANTERIS, NICHOLAS P (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:P
Last Name:MANTERIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 W 6TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1870
Mailing Address - Country:US
Mailing Address - Phone:720-508-3982
Mailing Address - Fax:720-287-1452
Practice Address - Street 1:2095 W 6TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1870
Practice Address - Country:US
Practice Address - Phone:720-508-3982
Practice Address - Fax:720-287-1452
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-27
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor