Provider Demographics
NPI:1316121551
Name:LAO, ALEXANDRA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:LAO
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 1:4003 PORTRAIT DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-9660
Mailing Address - Country:US
Mailing Address - Phone:386-235-6824
Mailing Address - Fax:
Practice Address - Street 1:270 CORNERSTONE DR STE 101
Practice Address - Street 2:CHRIOPRACTIC NUTRITION CENTER
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8400
Practice Address - Country:US
Practice Address - Phone:919-461-0046
Practice Address - Fax:919-461-0231
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1134153802OtherCORPORATE NPI NUMBER
NC2456082OtherMEDICARE PTAN
NC562116011OtherTIN