Provider Demographics
NPI:1972840668
Name:BRAXTON, LAKESHA THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:LAKESHA
Middle Name:THOMAS
Last Name:BRAXTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LAKESHA
Other - Middle Name:
Other - Last Name:THOMAS-BRAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1448 CHEYENNE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8164
Mailing Address - Country:US
Mailing Address - Phone:202-276-8210
Mailing Address - Fax:
Practice Address - Street 1:1448 CHEYENNE RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:202-276-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02152111N00000X
TX12516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor