Provider Demographics
NPI:1376966721
Name:ALEXANDRIA CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ALEXANDRIA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-763-9711
Mailing Address - Street 1:510 22ND AVE E
Mailing Address - Street 2:SUITE 701
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4653
Mailing Address - Country:US
Mailing Address - Phone:320-763-9711
Mailing Address - Fax:320-762-1278
Practice Address - Street 1:510 22ND AVE E
Practice Address - Street 2:SUITE 701
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-4653
Practice Address - Country:US
Practice Address - Phone:320-763-9711
Practice Address - Fax:320-762-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5835OtherCHIROPRACTIC LICENSE NUMBER