Healthcare Provider Details

I. General information

NPI: 1194649764
Provider Name (Legal Business Name): ALEXIS CHUM IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 S STEWART AVE
SPRINGFIELD MO
65804-2519
US

IV. Provider business mailing address

1834 S STEWART AVE
SPRINGFIELD MO
65804-2519
US

V. Phone/Fax

Practice location:
  • Phone: 417-883-1141
  • Fax: 417-889-6627
Mailing address:
  • Phone: 417-883-1141
  • Fax: 417-889-6627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-322761
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: