Provider Demographics
NPI:1619156114
Name:HASKELL, ALEXANDER H (ND)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:H
Last Name:HASKELL
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 PROSPECTOR AVE
Mailing Address - Street 2:STE. 30
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7207
Mailing Address - Country:US
Mailing Address - Phone:435-658-0500
Mailing Address - Fax:435-658-0520
Practice Address - Street 1:1901 PROSPECTOR AVE
Practice Address - Street 2:STE. 30
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7207
Practice Address - Country:US
Practice Address - Phone:435-658-0500
Practice Address - Fax:435-658-0520
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6718543-7101175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath