Healthcare Provider Details

I. General information

NPI: 1497800205
Provider Name (Legal Business Name): ALEXA ELIZABETH VALDEZ D.C., L.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXA ELIZABETH FAGAN D.C.

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S FLORIDA AVE
LAKELAND FL
33803-2655
US

IV. Provider business mailing address

1923 S FLORIDA AVE
LAKELAND FL
33803-2655
US

V. Phone/Fax

Practice location:
  • Phone: 863-683-4663
  • Fax: 833-449-4193
Mailing address:
  • Phone: 813-468-5887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW460
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 9333
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: