Provider Demographics
NPI:1144841321
Name:HALSTEAD, ALEXANDER CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:CHARLES
Last Name:HALSTEAD
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 1:5456 N NEWCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-2052
Mailing Address - Country:US
Mailing Address - Phone:517-740-6762
Mailing Address - Fax:
Practice Address - Street 1:402 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2845
Practice Address - Country:US
Practice Address - Phone:847-920-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor