Provider Demographics
NPI:1780159798
Name:ROMERO, ALEXIS (DC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:ROMERO
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 1:151 SAWGRASS CORNERS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3554
Mailing Address - Country:US
Mailing Address - Phone:904-373-5852
Mailing Address - Fax:
Practice Address - Street 1:151 SAWGRASS CORNERS DR STE 102
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3554
Practice Address - Country:US
Practice Address - Phone:904-373-5853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor