Healthcare Provider Details

I. General information

NPI: 1982408274
Provider Name (Legal Business Name): ALEXANDRA MARIE WING-LACLAIRE DC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CLEMENT ST
SAN FRANCISCO CA
94118-2419
US

IV. Provider business mailing address

295 8TH AVE APT 3
SAN FRANCISCO CA
94118-2596
US

V. Phone/Fax

Practice location:
  • Phone: 415-497-0130
  • Fax:
Mailing address:
  • Phone: 413-834-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberRHC00207972
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDC36831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: