Individual
ALEXANDER ANTON PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
W5675 COUNTY ROAD B, SHAWANO, WI 54166-6901
(715) 526-6158
Mailing address
8732 POLK ST NE, BLAINE, MN 55434-2346
(763) 439-6576
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5599-12
WI
111N00000X
Chiropractor
6646
MN
Other
Enumeration date
01/05/2021
Last updated
01/05/2021
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