Healthcare Provider Details

I. General information

NPI: 1568686103
Provider Name (Legal Business Name): JODY K SHEVINS ND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5377 MANHATTAN CIRCLE SUITE 200
BOULDER CO
80303
US

IV. Provider business mailing address

5377 MANHATTAN CIRCLE SUITE 200
BOULDER CO
80303
US

V. Phone/Fax

Practice location:
  • Phone: 303-494-3713
  • Fax: 303-494-3882
Mailing address:
  • Phone: 303-494-3713
  • Fax: 303-494-3882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0599
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name: JODY K SHEVINS
Title or Position: OWNER PRESIDENT
Credential: ND
Phone: 303-494-3713