Individual
DIERDRE MANGAN I
Active
Individual
DIERDRE MANGAN I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
2667
CO
225700000X
Massage Therapist
Primary
0011644
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0011644
MASSAGE LICENSE
CO
01
—
846955
ACUPUNCTURE LICENSE
CO
Enumeration date
10/14/2022
Last updated
10/14/2022
Update your record
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