Provider Demographics
NPI:1477131662
Name:COLE, ALEXANDER RYAN (DC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:RYAN
Last Name:COLE
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 1:312 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-1258
Mailing Address - Country:US
Mailing Address - Phone:608-846-3337
Mailing Address - Fax:
Practice Address - Street 1:725 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-2811
Practice Address - Country:US
Practice Address - Phone:608-837-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5632-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor