Provider Demographics
NPI:1326311770
Name:AXIS NATURAL MEDICINE, LLC
Entity Type:Organization
Organization Name:AXIS NATURAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRAYDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DOM
Authorized Official - Phone:239-288-0900
Mailing Address - Street 1:7680 CAMBRIDGE MANOR PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3671
Mailing Address - Country:US
Mailing Address - Phone:239-288-0900
Mailing Address - Fax:239-985-9470
Practice Address - Street 1:7680 CAMBRIDGE MANOR PL
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3671
Practice Address - Country:US
Practice Address - Phone:239-288-0900
Practice Address - Fax:239-985-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8741111N00000X
FLAP2378171100000X
FLAP2869171100000X
FLMA46855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty