Provider Demographics
NPI:1417579251
Name:ALLIS, ALEXIS OLIVIA (DC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:OLIVIA
Last Name:ALLIS
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 1:54420 STATE HIGHWAY 109
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:MN
Mailing Address - Zip Code:56097-6101
Mailing Address - Country:US
Mailing Address - Phone:206-755-6144
Mailing Address - Fax:
Practice Address - Street 1:313 MAIN ST NE
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:MN
Practice Address - Zip Code:56065
Practice Address - Country:US
Practice Address - Phone:507-524-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor