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General NPI Number Information
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NPI Number | 1053131714
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Entity Type | Individual
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Provider Name | ALEXANDRA NICHOLE MAHAN DC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 1810 KNOX AVE
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City | NORTH AUGUSTA
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State | SC
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Zip | 29841-2903
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Country | US
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Telephone | 803-599-5902
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Fax |
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Provider Business Mailing Address
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Address Line | 388 AGAPE LN
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City | TRENTON
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State | SC
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Zip | 29847-2535
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Country | US
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Telephone | 404-895-8339
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5121
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License Number State | SC
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