Healthcare Provider Details

I. General information

NPI: 1689692139
Provider Name (Legal Business Name): TROY L MANCHESTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 INDUSTRIAL CIR STE 2
LONGMONT CO
80501-6559
US

IV. Provider business mailing address

8364 W FORK RD
BOULDER CO
80302-9383
US

V. Phone/Fax

Practice location:
  • Phone: 303-682-2473
  • Fax:
Mailing address:
  • Phone: 650-421-5445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberDR.0062776
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: