Provider Demographics
NPI:1053630483
Name:POLSON, AMBER DE ANN (DC, MS)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:DE ANN
Last Name:POLSON
Suffix:
Gender:F
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 HIGHWAY KK
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3345
Mailing Address - Country:US
Mailing Address - Phone:573-302-4444
Mailing Address - Fax:573-302-7903
Practice Address - Street 1:1190 HIGHWAY KK
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3345
Practice Address - Country:US
Practice Address - Phone:573-302-4444
Practice Address - Fax:573-302-7903
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010005583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1053630483Medicare PIN