Provider Demographics
NPI:1134365208
Name:ACEVEDO, ALEX JR (CHIRPRACTOR)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:ACEVEDO
Suffix:JR
Gender:M
Credentials:CHIRPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20072 SW BIRCH ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0794
Mailing Address - Country:US
Mailing Address - Phone:949-752-2400
Mailing Address - Fax:949-752-2401
Practice Address - Street 1:20072 SW BIRCH ST
Practice Address - Street 2:SUITE 170
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0794
Practice Address - Country:US
Practice Address - Phone:949-752-2400
Practice Address - Fax:949-752-2401
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 22950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor