Provider Demographics
NPI:1497800205
Name:VALDEZ, ALEXA ELIZABETH (DC, LM)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:ELIZABETH
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:DC, LM
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:ELIZABETH
Other - Last Name:FAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1923 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2655
Mailing Address - Country:US
Mailing Address - Phone:813-468-5887
Mailing Address - Fax:
Practice Address - Street 1:1923 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2655
Practice Address - Country:US
Practice Address - Phone:863-683-4663
Practice Address - Fax:833-449-4193
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW460176B00000X
FLCH 9333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
No176B00000XOther Service ProvidersMidwifeGroup - Single Specialty