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NPI Code Detail

MEDICARE: MR. ALEXANDER A KIRICHENKO LMT

MEDICARE: MR. ALEXANDER A KIRICHENKO LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMA89591FL

General Provider Information

NPI Number : 1215798384
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALEXANDER A KIRICHENKO LMT
Provider Business Mailing Address
First Line : 13770 BEACH BLVD STE 4
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-7227
Country : US
Telephone Number : 904-539-3352
Fax Number : 904-539-3351
Provider Business Practice Location Address
First Line : 13770 BEACH BLVD STE 4
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-7227
Country : US
Telephone Number : 904-539-3352
Fax Number : 904-539-3351
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2024
Last Update Date : 01/17/2024

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