Provider Demographics
NPI:1003243692
Name:SEDONA INTEGRATIVE OSTEOPATHY LLC
Entity Type:Organization
Organization Name:SEDONA INTEGRATIVE OSTEOPATHY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURGOON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-327-4101
Mailing Address - Street 1:6486 SR 179
Mailing Address - Street 2:BLDG D SUITE 108
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-7993
Mailing Address - Country:US
Mailing Address - Phone:520-327-4101
Mailing Address - Fax:
Practice Address - Street 1:6486 SR 179
Practice Address - Street 2:BLDG D SUITE 108
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-7993
Practice Address - Country:US
Practice Address - Phone:520-327-4101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006216208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty