Healthcare Provider Details

I. General information

NPI: 1811057904
Provider Name (Legal Business Name): BRUCE ALEXANDER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 EDISON FURLONG RD
FURLONG PA
18925-1026
US

IV. Provider business mailing address

630 EDISON FURLONG RD P.O. BOX 415
FURLONG PA
18925-1026
US

V. Phone/Fax

Practice location:
  • Phone: 215-348-9090
  • Fax: 215-348-9090
Mailing address:
  • Phone: 215-348-9090
  • Fax: 215-348-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC002689L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: