Provider Demographics
NPI:1831254689
Name:ZYLSTRA, ALEX HUGH (DC)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:HUGH
Last Name:ZYLSTRA
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 1:7517 CUSTER RD W
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8138
Mailing Address - Country:US
Mailing Address - Phone:253-473-7777
Mailing Address - Fax:253-473-2484
Practice Address - Street 1:7517 CUSTER RD W
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8138
Practice Address - Country:US
Practice Address - Phone:253-473-7777
Practice Address - Fax:253-473-2484
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0202206OtherL & I NUMBER
WAG8857747Medicare PIN
WAV07733Medicare UPIN
WAG8857746Medicare PIN