Provider Demographics
NPI:1790420750
Name:JESERITZ-COLEMAN, ALYXANDRA (DC)
Entity Type:Individual
Prefix:DR
First Name:ALYXANDRA
Middle Name:
Last Name:JESERITZ-COLEMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ALYX
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:730 CLEVELAND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1345
Mailing Address - Country:US
Mailing Address - Phone:651-699-8610
Mailing Address - Fax:651-699-1207
Practice Address - Street 1:730 CLEVELAND AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1345
Practice Address - Country:US
Practice Address - Phone:651-699-8610
Practice Address - Fax:651-699-1207
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor