Provider Demographics
NPI:1881797660
Name:WILLIAMS, SHANE MANSON (DC)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:MANSON
Last Name:WILLIAMS
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 1:319 ABC UNIT A
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-3516
Mailing Address - Country:US
Mailing Address - Phone:970-925-7844
Mailing Address - Fax:
Practice Address - Street 1:319 ABC UNIT A
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-3516
Practice Address - Country:US
Practice Address - Phone:970-925-7844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5135111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician