Provider Demographics
NPI:1770628232
Name:CHRISTIAN, KEITH E (DOM)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:E
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:813 PASEO DEL PUEBLO NORTE
Mailing Address - Street 2:PO BOX 2717
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6373
Mailing Address - Country:US
Mailing Address - Phone:505-758-8498
Mailing Address - Fax:505-751-7337
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:505-758-8498
Practice Address - Fax:505-751-7337
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM453171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist