Provider Demographics
NPI:1023301157
Name:RODDVIK, ALEXANDER (DC)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:RODDVIK
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 1:1512 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1142
Mailing Address - Country:US
Mailing Address - Phone:541-399-0930
Mailing Address - Fax:206-339-7388
Practice Address - Street 1:501 PORTWAY AVE STE 203
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1288
Practice Address - Country:US
Practice Address - Phone:541-406-0849
Practice Address - Fax:541-716-5274
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor