Provider Demographics
NPI:1669420378
Name:KHANIN, ALEXANDER (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:KHANIN
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 1:7050 S HIGHLAND DR STE 240
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3761
Mailing Address - Country:US
Mailing Address - Phone:801-874-9620
Mailing Address - Fax:
Practice Address - Street 1:7050 S HIGHLAND DR STE 240
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-3761
Practice Address - Country:US
Practice Address - Phone:801-874-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12407599-1202111N00000X
CADC 27993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0279930Medicare PIN