Provider Demographics
NPI:1083809859
Name:WENDY LYNN POLHEMUS
Entity Type:Organization
Organization Name:WENDY LYNN POLHEMUS
Other - Org Name:HANDS ON FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:POLHEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-505-0001
Mailing Address - Street 1:21 BROADWAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8058
Mailing Address - Country:US
Mailing Address - Phone:201-505-0001
Mailing Address - Fax:201-505-4844
Practice Address - Street 1:21 BROADWAY
Practice Address - Street 2:SUITE E
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8058
Practice Address - Country:US
Practice Address - Phone:201-505-0001
Practice Address - Fax:201-505-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00498100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1831261585OtherINDIVIDUAL NPI
NJ022068Medicare PIN