Provider Demographics
NPI:1598861577
Name:ALEXANDER, KEN D (DC)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:D
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:DALE
Other - Last Name:ALEXANDER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3406 BROADWAY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2404
Mailing Address - Country:US
Mailing Address - Phone:816-531-3300
Mailing Address - Fax:
Practice Address - Street 1:3406 BROADWAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2404
Practice Address - Country:US
Practice Address - Phone:816-531-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5908111NS0005X
KSC-4046111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO19016011OtherBC/BS NUMBER/CHIROPRACTIC
MOD524937Medicare PIN
MOU11994Medicare UPIN