Provider Demographics
NPI:1437181492
Name:POLASEK, BOBBIE JO (DC)
Entity Type:Individual
Prefix:DR
First Name:BOBBIE
Middle Name:JO
Last Name:POLASEK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2944 MOTLEY DR
Mailing Address - Street 2:SUITE 314
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3460
Mailing Address - Country:US
Mailing Address - Phone:972-270-9200
Mailing Address - Fax:972-270-9202
Practice Address - Street 1:2944 MOTLEY DR
Practice Address - Street 2:SUITE 314
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3460
Practice Address - Country:US
Practice Address - Phone:972-270-9200
Practice Address - Fax:972-270-9202
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC9371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AJ376OtherBLUE CROSS BLUE SHIELD OF