Provider Demographics
NPI:1205224243
Name:JOLLY, ALEX (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:JOLLY
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 1:113 SULPHUR RIVER LOOP
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-4466
Mailing Address - Country:US
Mailing Address - Phone:651-689-3331
Mailing Address - Fax:
Practice Address - Street 1:61 N KEGLEY RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-4067
Practice Address - Country:US
Practice Address - Phone:254-899-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6007111N00000X
TX15533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor