Provider Demographics
NPI:1053131714
Name:MAHAN, ALEXANDRA NICHOLE (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:NICHOLE
Last Name:MAHAN
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 1:388 AGAPE LN
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:SC
Mailing Address - Zip Code:29847-2535
Mailing Address - Country:US
Mailing Address - Phone:404-895-8339
Mailing Address - Fax:
Practice Address - Street 1:1810 KNOX AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-2903
Practice Address - Country:US
Practice Address - Phone:803-599-5902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor