Provider Demographics
NPI:1821224106
Name:SHROPSHIRE, KEN (MT)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:SHROPSHIRE
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 1:10701 MELODY DR
Mailing Address - Street 2:SUITE 414
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4130
Mailing Address - Country:US
Mailing Address - Phone:303-920-2350
Mailing Address - Fax:303-453-0427
Practice Address - Street 1:10701 MELODY DR
Practice Address - Street 2:SUITE 414
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4130
Practice Address - Country:US
Practice Address - Phone:303-920-2350
Practice Address - Fax:303-453-0427
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4409225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1104052489OtherESSENTIAL BODYWORKS, INC