Provider Demographics
NPI:1184770620
Name:GEBHARDT, ALEXANDER (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:GEBHARDT
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 1:415 E CROSSVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3037
Mailing Address - Country:US
Mailing Address - Phone:770-645-9595
Mailing Address - Fax:770-645-9522
Practice Address - Street 1:415 E CROSSVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3037
Practice Address - Country:US
Practice Address - Phone:770-645-9595
Practice Address - Fax:770-645-9522
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO007542111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIRO007542OtherSTATE OF GEORGIA LICENSE