Provider Demographics
NPI:1306911409
Name:ALEXANDER, KATHRYN PENNIMAN (DC CHIROPRACTOR)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PENNIMAN
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:DC CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037
Mailing Address - Country:US
Mailing Address - Phone:410-266-1638
Mailing Address - Fax:410-266-6205
Practice Address - Street 1:108 OLD SOLOMONS ISLAND RD
Practice Address - Street 2:BLDG 2 STE A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-266-1638
Practice Address - Fax:410-266-6205
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD502083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG3390001OtherBLUE CROSS BLUE SHIELD
MDM683OtherBLUE CROSS BLUE SHIELD
U98528Medicare UPIN
MD180SMedicare ID - Type Unspecified