Healthcare Provider Details

I. General information

NPI: 1578392890
Provider Name (Legal Business Name): RADIANCE NATURAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314B CENTRAL AVE
DOVER NH
03820-4133
US

IV. Provider business mailing address

6 ROSS RD
ROLLINSFORD NH
03869-5910
US

V. Phone/Fax

Practice location:
  • Phone: 603-534-2334
  • Fax:
Mailing address:
  • Phone: 603-534-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: THALIA DE JESUS DAIN
Title or Position: OWNER & PRACTITIONER
Credential: L.AC., LMT
Phone: 603-534-2334