Provider Demographics
NPI:1598030397
Name:LIGHT HARMONICS INSTITUTE
Entity Type:Organization
Organization Name:LIGHT HARMONICS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF ORIENTAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERDON
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, LIC AC
Authorized Official - Phone:505-989-4610
Mailing Address - Street 1:7608 OLD SANTA FE TRL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-9359
Mailing Address - Country:US
Mailing Address - Phone:505-989-4610
Mailing Address - Fax:505-989-4126
Practice Address - Street 1:7608 OLD SANTA FE TRL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-9359
Practice Address - Country:US
Practice Address - Phone:505-989-4610
Practice Address - Fax:505-989-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM994171100000X
NY004048-1171100000X
175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty