Provider Demographics
NPI:1477094910
Name:CHISM, ALEXANDRA ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:CHISM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9514 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-1532
Mailing Address - Country:US
Mailing Address - Phone:618-971-8694
Mailing Address - Fax:
Practice Address - Street 1:585 MID RIVERS MALL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2152
Practice Address - Country:US
Practice Address - Phone:855-424-4761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO390200000X
MO2022003393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program