Provider Demographics
NPI:1093309296
Name:POLING, LANDON DANIEL
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:DANIEL
Last Name:POLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 HAMPSHIRE RD STE E
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2873
Mailing Address - Country:US
Mailing Address - Phone:805-341-1429
Mailing Address - Fax:
Practice Address - Street 1:890 HAMPSHIRE RD STE E
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2873
Practice Address - Country:US
Practice Address - Phone:805-341-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor