Provider Demographics
NPI:1134234412
Name:ALEXANDER, STEPHEN S (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:ALEXANDER
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 1:2511 ST. JOHNS BLUFF RD. SOUTH
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246
Mailing Address - Country:US
Mailing Address - Phone:904-645-7559
Mailing Address - Fax:904-241-0255
Practice Address - Street 1:2511 ST. JOHNS BLUFF RD. SOUTH
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246
Practice Address - Country:US
Practice Address - Phone:904-645-7559
Practice Address - Fax:904-241-0255
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382083100Medicaid
55669OtherBCBS
FL382083100Medicaid
FL55669YMedicare PIN