Provider Demographics
NPI:1750605325
Name:IARED, ALEXANDRA NICOLE (DC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:IARED
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 CLOVIS AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1151
Mailing Address - Country:US
Mailing Address - Phone:559-326-0546
Mailing Address - Fax:559-406-7142
Practice Address - Street 1:325 CLOVIS AVE STE 107
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1151
Practice Address - Country:US
Practice Address - Phone:559-326-0546
Practice Address - Fax:559-406-7142
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA344269111N00000X
CA31386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor