Healthcare Provider Details

I. General information

NPI: 1780893628
Provider Name (Legal Business Name): KEITH ADAM ALEXANDER DC, DCBCN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 18TH ST STE 100
KENOSHA WI
53140-4666
US

IV. Provider business mailing address

2717 18TH ST STE 100
KENOSHA WI
53140-4666
US

V. Phone/Fax

Practice location:
  • Phone: 262-484-4165
  • Fax: 262-484-4326
Mailing address:
  • Phone: 262-484-4165
  • Fax: 262-484-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number0104001349
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number038.012332
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number4717-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: