Healthcare Provider Details

I. General information

NPI: 1740481910
Provider Name (Legal Business Name): ALEXANDER HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 SPRING VALLEY RD SUITE 40
DALLAS TX
75244-3956
US

IV. Provider business mailing address

4801 SPRING VALLEY RD SUITE 40
DALLAS TX
75244-3956
US

V. Phone/Fax

Practice location:
  • Phone: 972-488-9686
  • Fax: 972-241-1936
Mailing address:
  • Phone: 972-488-9686
  • Fax: 972-241-1936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number10069
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number9801
License Number StateTX

VIII. Authorized Official

Name: BIJAN ROOSTAEI
Title or Position: BUSINESS MANAGER
Credential:
Phone: 972-488-9686