Provider Demographics
NPI:1164972717
Name:VANHOOSER, ALEXANDER (DC, MSR)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:VANHOOSER
Suffix:
Gender:M
Credentials:DC, MSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PLAIN ST.
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901
Mailing Address - Country:US
Mailing Address - Phone:812-549-8361
Mailing Address - Fax:
Practice Address - Street 1:10306 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2914
Practice Address - Country:US
Practice Address - Phone:502-245-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00740100111N00000X
KY5490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor