Provider Demographics
NPI:1104071539
Name:LAX, ADAM KEITH (RD/LDN)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:KEITH
Last Name:LAX
Suffix:
Gender:M
Credentials:RD/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 MULBERRY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4531
Mailing Address - Country:US
Mailing Address - Phone:954-292-5625
Mailing Address - Fax:772-334-8781
Practice Address - Street 1:1552 PALM BEACH LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2302
Practice Address - Country:US
Practice Address - Phone:954-292-5625
Practice Address - Fax:772-334-8781
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2293133V00000X, 136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, RegisteredGroup - Single Specialty