Healthcare Provider Details

I. General information

NPI: 1437677598
Provider Name (Legal Business Name): RAINING SUN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 FRONTIER AVE STE D
BOULDER CO
80301-2430
US

IV. Provider business mailing address

1455 ALPINE AVE
BOULDER CO
80304-3505
US

V. Phone/Fax

Practice location:
  • Phone: 720-989-1513
  • Fax:
Mailing address:
  • Phone: 303-919-2498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0002084
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number0002084
License Number StateCO

VIII. Authorized Official

Name: JAMISUN SKY VAN HORN
Title or Position: OWNER
Credential: DOM, LA.C, LMT
Phone: 303-919-2498