Provider Demographics
NPI:1992746028
Name:ALEXANDER, KURT M (DC)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:M
Last Name:ALEXANDER
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 1:523 S DOUBLEDAY ST
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-4353
Mailing Address - Country:US
Mailing Address - Phone:925-337-6526
Mailing Address - Fax:
Practice Address - Street 1:523 S DOUBLEDAY ST
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-4353
Practice Address - Country:US
Practice Address - Phone:925-337-6526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17608111N00000X
UT10852099-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T06516Medicare UPIN
ZZZ23247ZMedicare ID - Type Unspecified