Provider Demographics
NPI:1902434574
Name:ANDREWS, ALEXANDER
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:ANDREWS
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 1:410 E 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:ROYALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62983-1339
Mailing Address - Country:US
Mailing Address - Phone:618-780-4104
Mailing Address - Fax:
Practice Address - Street 1:410 E 3RD ST S
Practice Address - Street 2:
Practice Address - City:ROYALTON
Practice Address - State:IL
Practice Address - Zip Code:62983-1339
Practice Address - Country:US
Practice Address - Phone:618-780-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty