Provider Demographics
NPI:1891128880
Name:KOCHELAYEV, SERGEY VIKTOR (DC)
Entity type:Individual
Prefix:DR
First Name:SERGEY
Middle Name:VIKTOR
Last Name:KOCHELAYEV
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 1:800 164TH ST SE STE O
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6301
Mailing Address - Country:US
Mailing Address - Phone:425-737-5343
Mailing Address - Fax:425-745-9400
Practice Address - Street 1:800 164TH ST SE STE O
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6301
Practice Address - Country:US
Practice Address - Phone:425-737-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60537297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor