Active NPI
Dierdre Mangan I, LAC
- Massage Therapist
- Lakewood, CO
National Provider Identifier
1952027575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 0011644
- Practice address
- 2201 Kipling St
Lakewood, CO 80215-1580 - Phone
- (720) 998-4108
- NPI assigned
- Oct 14, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 2667 | CO | |
| Massage Therapist | 225700000X | 0011644 | CO | Primary |
Addresses
Primary practice location
2201 Kipling St
Lakewood, CO 80215-1580
Mailing address
2595 Nelson St
Lakewood, CO 80215-1334
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0011644 | Other | CO | MASSAGE LICENSE |
| 846955 | Other | CO | ACUPUNCTURE LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | dierdre@bumblebeeacu.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2667 | CO | MD | Acupuncturist |
| 0011644 | CO | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665705600000",
"number": "1952027575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2595 NELSON ST",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "802151334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2201 KIPLING ST",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "802151580",
"telephone_number": "720-998-4108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGAN",
"first_name": "DIERDRE",
"name_suffix": "I",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-14",
"last_updated": "2022-10-14",
"certification_date": "2022-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CO",
"license": "2667",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CO",
"license": "0011644",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSAGE LICENSE",
"identifier": "0011644",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ACUPUNCTURE LICENSE",
"identifier": "846955",
"state": "CO"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "dierdre@bumblebeeacu.com",
"affiliation": "N",
"address_1": "2201 Kipling St",
"city": "Lakewood",
"state": "CO",
"country_code": "US",
"postal_code": "802151580",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lakewood, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.