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General NPI Number Information
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NPI Number | 1669961868
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Entity Type | Individual
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Provider Name | SEAN DUGAN LAC
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Gender | Male
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Dates
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Enumeration Date | 05/03/2018
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Last Update Date | 05/01/2020
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Provider Practice Location Address
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Address Line | 6540 W EMERALD ST STE 100
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City | BOISE
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State | ID
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Zip | 83704-8782
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Country | US
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Telephone | 208-953-7690
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Fax |
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Provider Business Mailing Address
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Address Line | 4777 N WATERFRONT WAY
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City | BOISE
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State | ID
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Zip | 83703-2772
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Country | US
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Telephone | 208-953-7690
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Fax | 208-953-7690
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | A105
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | ACU354
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License Number State | ID
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