Provider Demographics
NPI:1508804675
Name:POLYAKOV, ALEKSEY (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEKSEY
Middle Name:
Last Name:POLYAKOV
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 1:3201 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHONEIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029
Mailing Address - Country:US
Mailing Address - Phone:623-773-2000
Mailing Address - Fax:877-599-5678
Practice Address - Street 1:13754 W BELL RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:847-731-6727
Practice Address - Fax:847-731-6739
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU97620Medicare UPIN
IL207653Medicare PIN
IL211403Medicare PIN