Healthcare Provider Details

I. General information

NPI: 1598030397
Provider Name (Legal Business Name): LIGHT HARMONICS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7608 OLD SANTA FE TRL
SANTA FE NM
87505-9359
US

IV. Provider business mailing address

7608 OLD SANTA FE TRL
SANTA FE NM
87505-9359
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-4610
  • Fax: 505-989-4126
Mailing address:
  • Phone: 505-989-4610
  • Fax: 505-989-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004048-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number994
License Number StateNM

VIII. Authorized Official

Name: DR. JOHN SHERDON
Title or Position: DOCTOR OF ORIENTAL MEDICINE
Credential: DOM, LIC. AC.
Phone: 505-989-4610