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General NPI Number Information
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NPI Number | 1215312327
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Entity Type | Organization
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Legal Business Name | SACRED VESSEL ACUPUNCTURE LLC.
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 1301 RIVERSIDE AVE SUITE #2
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City | FORT COLLINS
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State | CO
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Zip | 80524-4374
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Country | US
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Telephone | 970-214-0338
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Fax |
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Provider Business Mailing Address
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Address Line | 1914 CORVID WAY
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City | FORT COLLINS
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State | CO
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Zip | 80521-1328
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Country | US
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Telephone | 970-214-0338
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Fax |
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Authorized Official
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Title or Position | OWNER/ACUPUNCTURIST
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Name | MRS. SARAH ELIZABETH THOMPSON
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Credential | L.AC.,
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Telephone | 970-214-0338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1412
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License Number State | CO
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