Provider Demographics
NPI:1598496176
Name:POLARIS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:POLARIS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:DESSELLIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-296-4340
Mailing Address - Street 1:1539 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-4674
Mailing Address - Country:US
Mailing Address - Phone:763-296-4340
Mailing Address - Fax:
Practice Address - Street 1:1539 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-4674
Practice Address - Country:US
Practice Address - Phone:763-296-4340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty