Provider Demographics
NPI:1154052850
Name:ASTOR, ALEXIS MARILYN (DC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARILYN
Last Name:ASTOR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-2990
Mailing Address - Country:US
Mailing Address - Phone:515-227-7491
Mailing Address - Fax:888-594-7231
Practice Address - Street 1:20 N 29TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-2990
Practice Address - Country:US
Practice Address - Phone:515-227-7491
Practice Address - Fax:888-594-7231
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor