Provider Demographics
NPI:1720633977
Name:ALEXANDER, LANCE DAVID (DC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:DAVID
Last Name:ALEXANDER
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 1:133 W UNIVERSITY PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1968
Mailing Address - Country:US
Mailing Address - Phone:731-664-7935
Mailing Address - Fax:731-668-6631
Practice Address - Street 1:133 W UNIVERSITY PKWY STE 105
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1968
Practice Address - Country:US
Practice Address - Phone:731-664-7935
Practice Address - Fax:731-668-6631
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor