Provider Demographics
NPI:1164279907
Name:KUBULAK, ALEXA FAITH (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:FAITH
Last Name:KUBULAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18012 GARDNER DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2188
Mailing Address - Country:US
Mailing Address - Phone:908-616-1213
Mailing Address - Fax:
Practice Address - Street 1:5025 WINTERS CHAPEL RD STE H
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30360-1700
Practice Address - Country:US
Practice Address - Phone:770-399-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR011182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor