Provider Demographics
NPI:1609204510
Name:ANTHOFER, ALEX JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:JAMES
Last Name:ANTHOFER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WOODBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:IA
Mailing Address - Zip Code:50658-7772
Mailing Address - Country:US
Mailing Address - Phone:641-435-2102
Mailing Address - Fax:
Practice Address - Street 1:12 WOODBRIDGE ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:IA
Practice Address - Zip Code:50658-7772
Practice Address - Country:US
Practice Address - Phone:641-435-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor