Provider Demographics
NPI:1376913582
Name:POLAND CHIROPRACTIC INC
Entity Type:Organization
Organization Name:POLAND CHIROPRACTIC INC
Other - Org Name:POLAND CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:H DALE
Authorized Official - Middle Name:H
Authorized Official - Last Name:POLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-845-6722
Mailing Address - Street 1:228 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4410
Mailing Address - Country:US
Mailing Address - Phone:715-845-6722
Mailing Address - Fax:
Practice Address - Street 1:228 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4410
Practice Address - Country:US
Practice Address - Phone:715-845-6722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1404-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty