Provider Demographics
NPI:1992799217
Name:COLANERO, ALEXANDER F (DC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:F
Last Name:COLANERO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:COLANERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:738 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3415
Mailing Address - Country:US
Mailing Address - Phone:323-464-2000
Mailing Address - Fax:323-464-4000
Practice Address - Street 1:738 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-3415
Practice Address - Country:US
Practice Address - Phone:323-464-2000
Practice Address - Fax:323-464-4000
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0209410Medicaid
U63608Medicare UPIN
DC20941Medicare ID - Type Unspecified