Provider Demographics
NPI:1316722929
Name:PONTHIER, ALEX MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:MICHAEL
Last Name:PONTHIER
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 1:1845 EASTWEST PKWY STE 10
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-6405
Mailing Address - Country:US
Mailing Address - Phone:904-425-9060
Mailing Address - Fax:
Practice Address - Street 1:1845 EASTWEST PKWY STE 10
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-6405
Practice Address - Country:US
Practice Address - Phone:904-425-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor