Healthcare Provider Details

I. General information

NPI: 1598861577
Provider Name (Legal Business Name): KEN D ALEXANDER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KENNETH DALE ALEXANDER JR. DC

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 BROADWAY ST SUITE A
KANSAS CITY MO
64111-2404
US

IV. Provider business mailing address

3406 BROADWAY ST SUITE A
KANSAS CITY MO
64111-2404
US

V. Phone/Fax

Practice location:
  • Phone: 816-531-3300
  • Fax:
Mailing address:
  • Phone: 816-531-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5908
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberC-4046
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: