Provider Demographics
NPI:1255677340
Name:ALEXANDER CHIROPRACTIC NEUROLOGY CENTER, LLC
Entity Type:Organization
Organization Name:ALEXANDER CHIROPRACTIC NEUROLOGY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DCBCN
Authorized Official - Phone:262-484-4165
Mailing Address - Street 1:12719 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-5336
Mailing Address - Country:US
Mailing Address - Phone:262-484-4165
Mailing Address - Fax:262-484-4326
Practice Address - Street 1:12719 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-5336
Practice Address - Country:US
Practice Address - Phone:262-484-4165
Practice Address - Fax:262-484-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4717-12111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty