Provider Demographics
NPI:1083093066
Name:PORTNER, ALEXANDER JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JOHN
Last Name:PORTNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-0848
Mailing Address - Country:US
Mailing Address - Phone:919-552-0751
Mailing Address - Fax:919-552-0891
Practice Address - Street 1:131 W. HOLLY SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7083
Practice Address - Country:US
Practice Address - Phone:919-552-0751
Practice Address - Fax:919-552-0891
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-24
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70012661111N00000X
NC4768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor