Provider Demographics
NPI:1285663906
Name:KALIAKIN, ALEX (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:KALIAKIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23480 W MOON SHADOWS DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3034
Mailing Address - Country:US
Mailing Address - Phone:310-829-2225
Mailing Address - Fax:310-828-6926
Practice Address - Street 1:2317 BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2915
Practice Address - Country:US
Practice Address - Phone:310-829-2225
Practice Address - Fax:310-828-6926
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17695Medicare UPIN