Provider Demographics
NPI:1912988841
Name:POLETAJEV, VICTOR (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:POLETAJEV
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 1:5107 BRYSON TRL
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3063
Mailing Address - Country:US
Mailing Address - Phone:615-867-7522
Mailing Address - Fax:615-867-3288
Practice Address - Street 1:5107 BRYSON TRL
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3063
Practice Address - Country:US
Practice Address - Phone:615-867-7522
Practice Address - Fax:615-867-3288
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV528111N00000X
PADC-003771-L111N00000X
AL1878111N00000X
TNDC-001053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3093995OtherBLUE CROSS BLUE SHIELD
TN4482273OtherAETNA
TN3970120Medicare ID - Type Unspecified
TN3093995OtherBLUE CROSS BLUE SHIELD