Provider Demographics
NPI:1013258755
Name:IRIZARRY, ALEJANDRA AMARILIS (DC)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:AMARILIS
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2913
Mailing Address - Country:US
Mailing Address - Phone:208-906-1564
Mailing Address - Fax:
Practice Address - Street 1:14 W FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2913
Practice Address - Country:US
Practice Address - Phone:208-906-1564
Practice Address - Fax:208-906-1464
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1366111N00000X
PR490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor