Provider Demographics
NPI:1609011899
Name:MANSUR, JENNIFER (LAC, DIPL AC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:MANSUR
Suffix:
Gender:F
Credentials:LAC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 WINDCHIME PL
Mailing Address - Street 2:STE 301
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1933
Mailing Address - Country:US
Mailing Address - Phone:719-650-1421
Mailing Address - Fax:425-660-1421
Practice Address - Street 1:487 WINDCHIME PL
Practice Address - Street 2:STE 301
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1933
Practice Address - Country:US
Practice Address - Phone:719-650-1421
Practice Address - Fax:425-660-1421
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1330171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist