Provider Demographics
NPI:1942345806
Name:KRUCHAKOV, ALEKSANDR (AP, MA)
Entity Type:Individual
Prefix:MR
First Name:ALEKSANDR
Middle Name:
Last Name:KRUCHAKOV
Suffix:
Gender:M
Credentials:AP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 NE 183RD ST
Mailing Address - Street 2:APT. 1603
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2104
Mailing Address - Country:US
Mailing Address - Phone:954-536-9231
Mailing Address - Fax:305-893-5208
Practice Address - Street 1:1531 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-2849
Practice Address - Country:US
Practice Address - Phone:954-922-1270
Practice Address - Fax:954-922-1273
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1714171100000X
FLMA 21878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist