Provider Demographics
NPI:1225529597
Name:ALEXANIAN, POLETTE (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:POLETTE
Middle Name:
Last Name:ALEXANIAN
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 MILFORD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3007
Mailing Address - Country:US
Mailing Address - Phone:818-427-3317
Mailing Address - Fax:
Practice Address - Street 1:421 E ANGELENO AVE STE 204
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501
Practice Address - Country:US
Practice Address - Phone:818-427-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34221111N00000X
CA18033171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist