Provider Demographics
NPI:1780893628
Name:ALEXANDER, KEITH ADAM (DC, DCBCN)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ADAM
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:DC, DCBCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 18TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-4666
Mailing Address - Country:US
Mailing Address - Phone:262-484-4165
Mailing Address - Fax:262-484-4326
Practice Address - Street 1:2717 18TH ST STE 100
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-4666
Practice Address - Country:US
Practice Address - Phone:262-484-4165
Practice Address - Fax:262-484-4326
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001349111NN0400X
IL038.012332111NN0400X
WI4717-12111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology