MEDICARE: SACRED VESSEL ACUPUNCTURE LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	1412	CO

General Provider Information

NPI Number	:	1215312327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED VESSEL ACUPUNCTURE LLC.

Provider Business Mailing Address
First Line	:	1914 CORVID WAY
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-1328
Country	:	US
Telephone Number	:	970-214-0338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 RIVERSIDE AVE
Second Line	:	SUITE #2
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4374
Country	:	US
Telephone Number	:	970-214-0338
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ACUPUNCTURIST
Name	:	MRS. SARAH ELIZABETH THOMPSON
Credential	:	L.AC.,
Telephone Number	:	970-214-0338

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	07/30/2015

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