Provider Demographics
NPI:1528402450
Name:ALEXIS, ALYSSA ANDREA (LMP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANDREA
Last Name:ALEXIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 3RD ST SE
Mailing Address - Street 2:UNIT A
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17620 140TH AVE SE
Practice Address - Street 2:SUITE C-5
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-6813
Practice Address - Country:US
Practice Address - Phone:425-228-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60343902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor