Provider Demographics
NPI:1023627650
Name:GARCIA, ALEXA RAE (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:RAE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:RAE
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 LOMAS SANTA FE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1258
Mailing Address - Country:US
Mailing Address - Phone:858-847-2184
Mailing Address - Fax:858-847-2449
Practice Address - Street 1:124 LOMAS SANTA FE DR STE 203
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1258
Practice Address - Country:US
Practice Address - Phone:858-847-2184
Practice Address - Fax:858-847-2449
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC43891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC43891OtherLICENSE