=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568726115
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEXODINE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2012
-----------------------------------------------------
Last Update Date | 06/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 813 PASEO DEL PUEBLO NORTE
-----------------------------------------------------
City | TAOS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87571-6373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-758-8498
-----------------------------------------------------
Fax | 575-751-7337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 813 PASEO DEL PUEBLO NORTE
-----------------------------------------------------
City | TAOS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87571-6373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-758-8498
-----------------------------------------------------
Fax | 575-751-7337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KEITH E CHRISTIAN
-----------------------------------------------------
Credential | DOM
-----------------------------------------------------
Telephone | 575-758-8498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 453RX1
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------