Provider Demographics
NPI:1245317148
Name:SICRE, ALEXANDRE MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRE
Middle Name:MICHAEL
Last Name:SICRE
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 1:13224 SR 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-9403
Mailing Address - Country:US
Mailing Address - Phone:571-220-1361
Mailing Address - Fax:
Practice Address - Street 1:13224 SR 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-9403
Practice Address - Country:US
Practice Address - Phone:571-220-1361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13828111N00000X
VA0104555805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC00B718A37Medicare PIN