Provider Demographics
NPI:1801992797
Name:TARPOFF, ALEXANDER II (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:TARPOFF
Suffix:II
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:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-0397
Mailing Address - Country:US
Mailing Address - Phone:618-797-1242
Mailing Address - Fax:618-931-0530
Practice Address - Street 1:3674 ST RTE 111
Practice Address - Street 2:
Practice Address - City:PONTOON BEACH
Practice Address - State:IL
Practice Address - Zip Code:62040-0397
Practice Address - Country:US
Practice Address - Phone:618-797-1242
Practice Address - Fax:618-931-0530
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6045740OtherBCBS IL
ILT38677Medicare PIN
IL6045740OtherBCBS IL