Provider Demographics
NPI:1063055960
Name:MANCUSO, MATHEW (DC)
Entity type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:
Last Name:MANCUSO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9090 SOUTH RIDGELINE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129
Mailing Address - Country:US
Mailing Address - Phone:303-683-9494
Mailing Address - Fax:303-683-2411
Practice Address - Street 1:9090 SOUTH RIDGELINE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129
Practice Address - Country:US
Practice Address - Phone:303-683-9494
Practice Address - Fax:303-683-2411
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR0008095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor