Provider Demographics
NPI:1033928163
Name:GUTIERREZ, ALEXANDER (DC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:GUTIERREZ
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 1:303 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:WI
Mailing Address - Zip Code:53956-1219
Mailing Address - Country:US
Mailing Address - Phone:920-326-0203
Mailing Address - Fax:
Practice Address - Street 1:303 N HIGH ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:WI
Practice Address - Zip Code:53956-1219
Practice Address - Country:US
Practice Address - Phone:920-326-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6228-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor