Provider Demographics
NPI:1174979645
Name:SAGUM ACUPUNCTURE, LLC
Entity type:Organization
Organization Name:SAGUM ACUPUNCTURE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGUM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:303-773-1166
Mailing Address - Street 1:6059 S QUEBEC ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4514
Mailing Address - Country:US
Mailing Address - Phone:303-773-1166
Mailing Address - Fax:
Practice Address - Street 1:6059 S QUEBEC ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4514
Practice Address - Country:US
Practice Address - Phone:303-773-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002187171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty