Wandering Sage Medicine LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

ACU1624 Issued in CO

Legal business name

WANDERING SAGE MEDICINE LLC

Doing business as

Colorado Integrative Medicine LLC

Practice address

1371 Hecla Dr
Suite E
Louisville, CO 80027-2327

Phone

(303) 530-0488

NPI assigned

Nov 4, 2014

Last updated

Nov 4, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tracie E Dissinger, DP.OMNPI 1679873483

Title

Owner

Phone

(303) 530-0488

Specialties & licenses 1

Addresses

Other names 1

• Colorado Integrative Medicine LLC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tracie E Dissinger, LAC

  • Acupuncturist
  • Lafayette, CO
  • NPI 1679873483
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415059200000",
    "number": "1326443359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18838",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803081838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1371 HECLA DR",
            "address_2": "SUITE E",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800272327",
            "telephone_number": "303-530-0488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WANDERING SAGE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-04",
        "last_updated": "2014-11-04",
        "status": "A",
        "authorized_official_last_name": "DISSINGER",
        "authorized_official_first_name": "TRACIE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-530-0488",
        "authorized_official_credential": "DP.OM"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CO",
            "license": "ACU1624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colorado Integrative Medicine LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Walgreen Co (Walgreens #01286)
• Genevieve Rebecca Wallace, MD
• Judith Mary Wallace, RXN,NP
• Diana Walley, MNT
• James Richard Walsh Jr., DPT
• Xuemei Wang
• Kirigin Elstad Watkins, M.D.
• Erin Watson, OT
• Carla Weaver, MD
• Weaving Connections Somatic Therapy, LLC

• Acupuncturist in Louisville, CO
• Providers in Louisville, CO by specialty
• Acupuncturist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.