Healthcare Provider Details

I. General information

NPI: 1568726115
Provider Name (Legal Business Name): LEXODINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 PASEO DEL PUEBLO NORTE
TAOS NM
87571-6373
US

IV. Provider business mailing address

813 PASEO DEL PUEBLO NORTE
TAOS NM
87571-6373
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-8498
  • Fax: 575-751-7337
Mailing address:
  • Phone: 575-758-8498
  • Fax: 575-751-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number453RX1
License Number StateNM

VIII. Authorized Official

Name: KEITH E CHRISTIAN
Title or Position: OWNER
Credential: DOM
Phone: 575-758-8498