Provider Demographics
NPI:1194095729
Name:PARK, ALEXANDER SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:SCOTT
Last Name:PARK
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 1:36 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4059
Mailing Address - Country:US
Mailing Address - Phone:847-321-0605
Mailing Address - Fax:
Practice Address - Street 1:36 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4059
Practice Address - Country:US
Practice Address - Phone:847-518-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor