Provider Demographics
NPI:1164615449
Name:ALEXANDRIA SPINE & REHAB CENTER LLC
Entity Type:Organization
Organization Name:ALEXANDRIA SPINE & REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:KIRZNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-561-6250
Mailing Address - Street 1:1133 MACARTHUR DR
Mailing Address - Street 2:STE. B
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3123
Mailing Address - Country:US
Mailing Address - Phone:318-561-6250
Mailing Address - Fax:318-561-6252
Practice Address - Street 1:1133 MACARTHUR DR
Practice Address - Street 2:STE. B
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3123
Practice Address - Country:US
Practice Address - Phone:318-561-6250
Practice Address - Fax:318-561-6252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1900H3438ZOtherBCBS FEDERAL
669050OtherACN
5827464OtherCIGNA
H3438OtherBLUE CROSS
5827464OtherCIGNA
669050OtherACN
1900H3438ZOtherBCBS FEDERAL
=========OtherUNITED HEALTH CARE
LA4HOCT33Medicare PIN