Provider Demographics
NPI:1063147080
Name:ANDREADIS, ALEXANDER THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:THOMAS
Last Name:ANDREADIS
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 1:1878 SARAH LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-1558
Mailing Address - Country:US
Mailing Address - Phone:479-200-9359
Mailing Address - Fax:
Practice Address - Street 1:2060 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5910
Practice Address - Country:US
Practice Address - Phone:479-756-9661
Practice Address - Fax:855-279-1771
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor