Provider Demographics
NPI:1578789145
Name:JOHNSTON, SARA (LAC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6970 S HOLLY CIR STE 204
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1066
Mailing Address - Country:US
Mailing Address - Phone:720-882-1680
Mailing Address - Fax:
Practice Address - Street 1:6970 S HOLLY CIR STE 204
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1066
Practice Address - Country:US
Practice Address - Phone:720-882-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1061171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist