Provider Demographics
NPI:1538280623
Name:POLSINELLI, MICHAEL P (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:POLSINELLI
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 1:6501 WILSON MILLS RD STE B
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3442
Mailing Address - Country:US
Mailing Address - Phone:440-461-9774
Mailing Address - Fax:440-943-6716
Practice Address - Street 1:6501 WILSON MILLS RD STE B
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3442
Practice Address - Country:US
Practice Address - Phone:440-461-9774
Practice Address - Fax:440-943-6716
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH043727404-00OtherWORKERS COMP
OHH674461OtherMEDICARE - PTAN
OH000000361033OtherANTHEM AND BLUE CROSS
OHU93393Medicare UPIN