Provider Demographics
NPI:1679268304
Name:DOTEN, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:DOTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 VERNA TRL N
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4308
Mailing Address - Country:US
Mailing Address - Phone:207-570-0271
Mailing Address - Fax:
Practice Address - Street 1:201 N OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:HUDSON OAKS
Practice Address - State:TX
Practice Address - Zip Code:76087-7772
Practice Address - Country:US
Practice Address - Phone:207-570-0271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15622111N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program