MEDICARE: DR. ALAN KIETH ALEXANDER D.C.

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
1	111N00000X	Chiropractor	1628	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	5F982	OTHER	AR	MEDICARE GROUP PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5Y035	OTHER	AR	AR BCBS
2	11542398	OTHER	AR	CAQH

General Provider Information

NPI Number	:	1235145111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN KIETH ALEXANDER D.C.

Provider Business Mailing Address
First Line	:	3444 OLD GREENWOOD RD
Second Line	:	SUITE A
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5462
Country	:	US
Telephone Number	:	479-646-3984
Fax Number	:	479-646-2021

Provider Business Practice Location Address
First Line	:	3444 OLD GREENWOOD RD
Second Line	:	SUITE A
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5462
Country	:	US
Telephone Number	:	479-646-3984
Fax Number	:	479-646-2021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	01/07/2021

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Directions to “ DR. ALAN KIETH ALEXANDER D.C.” Practice Location

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