Healthcare Provider Details

I. General information

NPI: 1982533634
Provider Name (Legal Business Name): LIGHT AND SALT MISSIONARY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PKWY STE 314E
COLUMBIA MD
21044-6216
US

IV. Provider business mailing address

7739 OLD WOODSTOCK LN
ELLICOTT CITY MD
21043-6980
US

V. Phone/Fax

Practice location:
  • Phone: 443-355-7111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: CHULMIN JO
Title or Position: OWNER
Credential:
Phone: 443-710-3927