Provider Demographics
NPI:1265659064
Name:POLOCHICK, BRIAN M I (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:POLOCHICK
Suffix:I
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 1:2090 ACUSHNET AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-6310
Mailing Address - Country:US
Mailing Address - Phone:508-995-3428
Mailing Address - Fax:508-998-7262
Practice Address - Street 1:2090 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-6310
Practice Address - Country:US
Practice Address - Phone:508-995-3428
Practice Address - Fax:508-998-7262
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45350Medicare ID - Type Unspecified