Provider Demographics
NPI:1184956047
Name:VAN HORN, JAMISUN SKY (LAC, LMT, NCBTMB)
Entity type:Individual
Prefix:
First Name:JAMISUN
Middle Name:SKY
Last Name:VAN HORN
Suffix:
Gender:M
Credentials:LAC, LMT, NCBTMB
Other - Prefix:DR
Other - First Name:SKY
Other - Middle Name:
Other - Last Name:VAN HORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1455 ALPINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3505
Mailing Address - Country:US
Mailing Address - Phone:303-919-2498
Mailing Address - Fax:
Practice Address - Street 1:5603 ARAPAHOE AVE STE 5
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1377
Practice Address - Country:US
Practice Address - Phone:720-989-1513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4550225700000X
CO0002084171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist