Provider Demographics
NPI:1205907805
Name:JIMENEZ, ALEXANDER DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:DAVID
Last Name:JIMENEZ
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 1:11860 VISTA DEL SOL
Mailing Address - Street 2:SUITE 128
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6128
Mailing Address - Country:US
Mailing Address - Phone:915-412-6677
Mailing Address - Fax:866-574-1351
Practice Address - Street 1:11860 VISTA DEL SOL
Practice Address - Street 2:SUITE 128
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6128
Practice Address - Country:US
Practice Address - Phone:915-412-6677
Practice Address - Fax:866-574-1351
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDC2182111N00000X
FLRN9617241163W00000X
TXDC5807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C0040OtherBLUE CROSS BLUE SHIELD
TX87852KMedicare ID - Type Unspecified
TXU26329Medicare UPIN