Provider Demographics
NPI:1245996545
Name:EDWARDS, ALEXIS ELLEN (DC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ELLEN
Last Name:EDWARDS
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 1:335 SPINNAKER LOOP
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-2593
Mailing Address - Country:US
Mailing Address - Phone:805-407-1272
Mailing Address - Fax:512-858-4426
Practice Address - Street 1:800 W HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4191
Practice Address - Country:US
Practice Address - Phone:512-858-9355
Practice Address - Fax:512-858-4426
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor