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General NPI Number Information
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NPI Number | 1285309898
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Entity Type | Individual
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Provider Name | ALEC JON NASSIRZADEH DC
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Gender | Male
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 11820 ULYSSES ST NE SUITE 104
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City | BLAINE
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State | MN
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Zip | 55434
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Country | US
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Telephone | 763-330-1100
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Fax | 763-330-1102
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Provider Business Mailing Address
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Address Line | 290 MARKET ST UNIT 611
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City | MINNEAPOLIS
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State | MN
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Zip | 55405-1685
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Country | US
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Telephone | 763-330-1100
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Fax | 763-330-1102
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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 | 6877
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License Number State | MN
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