Provider Demographics
NPI:1275700460
Name:POLNY, BOHDAN STEPHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BOHDAN
Middle Name:STEPHAN
Last Name:POLNY
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 1:20151 SW BIRCH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1793
Mailing Address - Country:US
Mailing Address - Phone:949-851-5900
Mailing Address - Fax:949-851-5901
Practice Address - Street 1:20151 SW BIRCH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1793
Practice Address - Country:US
Practice Address - Phone:949-851-5900
Practice Address - Fax:949-851-5901
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor