Provider Demographics
NPI:1568726115
Name:LEXODINE, INC
Entity Type:Organization
Organization Name:LEXODINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:575-758-8498
Mailing Address - Street 1:813 PASEO DEL PUEBLO NORTE
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6373
Mailing Address - Country:US
Mailing Address - Phone:575-758-8498
Mailing Address - Fax:575-751-7337
Practice Address - Street 1:813 PASEO DEL PUEBLO NORTE
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6373
Practice Address - Country:US
Practice Address - Phone:575-758-8498
Practice Address - Fax:575-751-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM453RX1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty