Provider Demographics
NPI:1871275651
Name:OCTAVA, ALPHECCA MAY T (DC, MSAC)
Entity type:Individual
Prefix:DR
First Name:ALPHECCA MAY
Middle Name:T
Last Name:OCTAVA
Suffix:
Gender:F
Credentials:DC, MSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 ENCLAVE CIR UNIT D
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3588
Mailing Address - Country:US
Mailing Address - Phone:630-470-2740
Mailing Address - Fax:
Practice Address - Street 1:16140 STATE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1236
Practice Address - Country:US
Practice Address - Phone:815-417-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor