Provider Demographics
NPI:1184131195
Name:SASSER, JONATHAN MARION (MSOM, LAC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARION
Last Name:SASSER
Suffix:
Gender:M
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 FILLMORE PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1003
Mailing Address - Country:US
Mailing Address - Phone:505-603-8036
Mailing Address - Fax:
Practice Address - Street 1:1444 FILLMORE PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1003
Practice Address - Country:US
Practice Address - Phone:505-603-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002355171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist