Provider Demographics
NPI:1679268304
Name:DOTEN, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:DOTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 MAPLE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5406
Mailing Address - Country:US
Mailing Address - Phone:207-306-8086
Mailing Address - Fax:
Practice Address - Street 1:136 MAIN ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:WINTERPORT
Practice Address - State:ME
Practice Address - Zip Code:04496
Practice Address - Country:US
Practice Address - Phone:207-306-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX15622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program