Healthcare Provider Details

I. General information

NPI: 1417878232
Provider Name (Legal Business Name): YOUR NEXT STEP WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 DEPOT HILL RD STE 100
BROOMFIELD CO
80020-6738
US

IV. Provider business mailing address

1010 DEPOT HILL RD STE 100
BROOMFIELD CO
80020-6738
US

V. Phone/Fax

Practice location:
  • Phone: 720-819-6366
  • Fax: 888-649-9945
Mailing address:
  • Phone: 720-819-6366
  • Fax: 888-649-9945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. SHANE E. DITLOW
Title or Position: OWNER/PROVIDER
Credential: MT
Phone: 720-819-6366