Provider Demographics
NPI:1346636594
Name:ALEXIS, JEAN (DC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:ALEXIS
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 1:495 N RIVERSIDE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5908
Mailing Address - Country:US
Mailing Address - Phone:847-599-9900
Mailing Address - Fax:847-599-9901
Practice Address - Street 1:495 N RIVERSIDE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5908
Practice Address - Country:US
Practice Address - Phone:847-599-9900
Practice Address - Fax:847-599-9901
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor