Provider Demographics
NPI:1225694920
Name:MACIAS, ALEXANDRA (LAC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MACIAS
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1253
Mailing Address - Country:US
Mailing Address - Phone:615-894-5086
Mailing Address - Fax:
Practice Address - Street 1:4156 WESTPORT RD STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2705
Practice Address - Country:US
Practice Address - Phone:502-509-2407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001326171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist