Healthcare Provider Details

I. General information

NPI: 1144181462
Provider Name (Legal Business Name): THUNDERHEART HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E ROOSEVELT AVE
GRANTS NM
87020-2115
US

IV. Provider business mailing address

HC 61 BOX 1012
RAMAH NM
87321-9600
US

V. Phone/Fax

Practice location:
  • Phone: 505-990-8171
  • Fax:
Mailing address:
  • Phone: 505-990-8171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. EDWIN GREGORY MYERS
Title or Position: DIRECTOR
Credential: DOM, LMT
Phone: 505-990-8171