Healthcare Provider Details

I. General information

NPI: 1033093349
Provider Name (Legal Business Name): ALEXIUS R GARTRELL DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 W CHARLESTON BLVD STE 2-641
LAS VEGAS NV
89117-7528
US

IV. Provider business mailing address

3960 HARTNESS ST
MACON GA
31204-5631
US

V. Phone/Fax

Practice location:
  • Phone: 855-864-4322
  • Fax:
Mailing address:
  • Phone: 706-401-6093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR066525
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16924
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: