Provider Demographics
NPI:1285309898
Name:NASSIRZADEH, ALEC JON (DC)
Entity type:Individual
Prefix:DR
First Name:ALEC
Middle Name:JON
Last Name:NASSIRZADEH
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 1:290 MARKET ST UNIT 611
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-1685
Mailing Address - Country:US
Mailing Address - Phone:763-330-1100
Mailing Address - Fax:763-330-1102
Practice Address - Street 1:11820 ULYSSES ST NE
Practice Address - Street 2:SUITE 104
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434
Practice Address - Country:US
Practice Address - Phone:763-330-1100
Practice Address - Fax:763-330-1102
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor