Provider Demographics
NPI:1558033225
Name:BRANDT, ALEXA (DC)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:BRANDT
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 1:400 NW 1ST AVE APT 2506
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-1871
Mailing Address - Country:US
Mailing Address - Phone:720-227-5250
Mailing Address - Fax:
Practice Address - Street 1:5810 S UNIVERSITY DR STE 112
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-6116
Practice Address - Country:US
Practice Address - Phone:954-597-5916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14-139-0471OtherDRIVER'S LICENSE