Provider Demographics
NPI:1245828151
Name:WALTERS, ALYXANDRA BETH (DC)
Entity type:Individual
Prefix:
First Name:ALYXANDRA
Middle Name:BETH
Last Name:WALTERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CADILLAC DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2001
Mailing Address - Country:US
Mailing Address - Phone:615-669-1656
Mailing Address - Fax:
Practice Address - Street 1:18 CADILLAC DR STE 100
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2001
Practice Address - Country:US
Practice Address - Phone:615-669-1656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013655111N00000X
TN3567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor