Provider Demographics
NPI:1811764798
Name:GARCIA CONTRERAS, ALEXIS OMAR (DC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:OMAR
Last Name:GARCIA CONTRERAS
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 1:36338 CHRISTIAN RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-1286
Mailing Address - Country:US
Mailing Address - Phone:352-346-1560
Mailing Address - Fax:
Practice Address - Street 1:3155 AERIAL WAY
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-0629
Practice Address - Country:US
Practice Address - Phone:352-283-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty