Provider Demographics
NPI:1134635485
Name:ALEXANDER, SAMUEL ROBERT (DC, LN)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ROBERT
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:DC, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10725 202ND ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7861
Mailing Address - Country:US
Mailing Address - Phone:612-281-1240
Mailing Address - Fax:
Practice Address - Street 1:1700 S HWY 36 SERVICE DR
Practice Address - Street 2:#400
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2453
Practice Address - Country:US
Practice Address - Phone:507-519-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6450111N00000X
MNN257133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No111N00000XChiropractic ProvidersChiropractor