Provider Demographics
NPI:1083776439
Name:CANDOCIA, ALEXANDER JAVIER (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JAVIER
Last Name:CANDOCIA
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 1:124 W POLK ST
Mailing Address - Street 2:#801
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1784
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:124 W POLK ST
Practice Address - Street 2:#801
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1784
Practice Address - Country:US
Practice Address - Phone:312-583-9683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor