Provider Demographics
NPI:1679628515
Name:ALEXANDER, MATTHEW WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:ALEXANDER
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 1:3800 RAILROAD AVE
Mailing Address - Street 2:P.O. BOX 162
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9340
Mailing Address - Country:US
Mailing Address - Phone:315-589-9221
Mailing Address - Fax:888-505-5758
Practice Address - Street 1:3800 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-9340
Practice Address - Country:US
Practice Address - Phone:315-589-9221
Practice Address - Fax:888-505-5758
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7056094OtherAETNA
NYP010009459OtherBLUE CROSS BLUE SHIELD
NYP010009459OtherBLUE CROSS BLUE SHIELD