Provider Demographics
NPI:1235127507
Name:ALEXANDER, JEFFREY MARTIN (DC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MARTIN
Last Name:ALEXANDER
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 1:1038 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-9438
Mailing Address - Country:US
Mailing Address - Phone:330-674-4373
Mailing Address - Fax:330-777-8832
Practice Address - Street 1:1038 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-9438
Practice Address - Country:US
Practice Address - Phone:330-674-4373
Practice Address - Fax:330-777-8832
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0758225OtherMEDICARE PTAN
OH0960830Medicaid