Provider Demographics
NPI:1578605085
Name:DE POLO, HANK (DC)
Entity Type:Individual
Prefix:
First Name:HANK
Middle Name:
Last Name:DE POLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:HENRY
Other - Middle Name:L
Other - Last Name:DE POLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2160 E COUNTY ROAD 540A
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3740
Mailing Address - Country:US
Mailing Address - Phone:863-648-2006
Mailing Address - Fax:863-648-2393
Practice Address - Street 1:2160 E COUNTY ROAD 540A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3740
Practice Address - Country:US
Practice Address - Phone:863-648-2006
Practice Address - Fax:863-648-2393
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88589OtherBLUE CROSS BLUE SHIELD
FL88589OtherBLUE CROSS BLUE SHIELD