Provider Demographics
NPI:1316482805
Name:RED SAGE ACUPUNCTURE LLC
Entity type:Organization
Organization Name:RED SAGE ACUPUNCTURE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANN
Authorized Official - Middle Name:WHIDDEN
Authorized Official - Last Name:TURPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-572-7929
Mailing Address - Street 1:4741 ATLANTIC BLVD STE E2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-1138
Mailing Address - Country:US
Mailing Address - Phone:904-572-7929
Mailing Address - Fax:
Practice Address - Street 1:4741 ATLANTIC BLVD STE E2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-1138
Practice Address - Country:US
Practice Address - Phone:904-572-7929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3093171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty