Provider Demographics
NPI:1669294526
Name:BLACK, ALEXIS KAYE (DC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:KAYE
Last Name:BLACK
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LEXTIN DR
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-9316
Mailing Address - Country:US
Mailing Address - Phone:815-257-5394
Mailing Address - Fax:
Practice Address - Street 1:1355 E 19TH RD
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-9743
Practice Address - Country:US
Practice Address - Phone:815-257-5394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.014184111NI0013X, 111N00000X, 111NI0900X, 111NN0400X, 111NR0200X, 111NN1001X, 111NP0017X, 111NR0400X, 111NX0100X, 111NX0800X, 111NS0005X, 111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NI0900XChiropractic ProvidersChiropractorInternist
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NT0100XChiropractic ProvidersChiropractorThermography