Provider Demographics
NPI:1508042870
Name:ALEXANDER, LACEY LEIGH (DC)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:LEIGH
Last Name:ALEXANDER
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 1:104 FENESTRA LN
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-1101
Mailing Address - Country:US
Mailing Address - Phone:309-699-1315
Mailing Address - Fax:
Practice Address - Street 1:2603 S WASHINGTON ST
Practice Address - Street 2:SUITE 140
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-6370
Practice Address - Country:US
Practice Address - Phone:630-357-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor