Provider Demographics
NPI:1639174691
Name:GAFFORD, ALEX J (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:J
Last Name:GAFFORD
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 1:12117 LADUE HEIGHTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6656
Mailing Address - Country:US
Mailing Address - Phone:314-275-7802
Mailing Address - Fax:
Practice Address - Street 1:745 CRAIG RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7122
Practice Address - Country:US
Practice Address - Phone:314-275-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004013906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO189632OtherBLUE CROSS BLUE SHIELD
MO189632OtherBLUE CROSS BLUE SHIELD
V03608Medicare UPIN