Provider Demographics
NPI:1336894153
Name:CESAL, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:CESAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 COPPER RIDGE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6721
Mailing Address - Country:US
Mailing Address - Phone:810-931-9478
Mailing Address - Fax:
Practice Address - Street 1:4110 COPPER RIDGE DR STE 210
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6721
Practice Address - Country:US
Practice Address - Phone:231-943-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022002086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor