Provider Demographics
NPI:1134294192
Name:MCMINN, ALEX (DC)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:MCMINN
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 1:21351 GENTRY DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-8510
Mailing Address - Country:US
Mailing Address - Phone:703-406-8686
Mailing Address - Fax:703-406-8688
Practice Address - Street 1:21351 GENTRY DR
Practice Address - Street 2:SUITE 125
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8510
Practice Address - Country:US
Practice Address - Phone:703-406-8686
Practice Address - Fax:703-406-8688
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA211693OtherANTHEM
VA4400165OtherUHC
VA629493OtherACN
VA629493OtherACN
VA00W226901Medicare PIN