Provider Demographics
NPI:1386406668
Name:VAN DYKE, ALEXIS PAIGE (DC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:PAIGE
Last Name:VAN DYKE
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 1:444 WESTLAKE CTR
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1432
Mailing Address - Country:US
Mailing Address - Phone:415-347-7380
Mailing Address - Fax:
Practice Address - Street 1:444 WESTLAKE CTR
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1432
Practice Address - Country:US
Practice Address - Phone:415-347-7380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor