Provider Demographics
NPI:1144311937
Name:BIRREN, ALEX PATRI (DC)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:PATRI
Last Name:BIRREN
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 1:90 W GRAND BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2049
Mailing Address - Country:US
Mailing Address - Phone:951-549-6808
Mailing Address - Fax:951-549-6508
Practice Address - Street 1:90 W GRAND BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2049
Practice Address - Country:US
Practice Address - Phone:951-549-6808
Practice Address - Fax:951-549-6508
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0256600Medicare ID - Type Unspecified