Provider Demographics
NPI:1194807032
Name:CHAREST, ALEXANDRIA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:LYNN
Last Name:CHAREST
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 4TH AVE CIRCLE EAST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5621
Mailing Address - Country:US
Mailing Address - Phone:941-741-8739
Mailing Address - Fax:941-803-8319
Practice Address - Street 1:5220 4TH AVENUE CIRCLE EAST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:941-741-8739
Practice Address - Fax:941-803-8319
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89377OtherBLUE CROSS BLUE SHIELD
FL7557757OtherAETNA PROVIDER NUMBER
FLU99476Medicare UPIN
FL89377OtherBLUE CROSS BLUE SHIELD