Provider Demographics
NPI:1619125275
Name:POLVERINO, FRANK FRANCIS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:FRANCIS
Last Name:POLVERINO
Suffix:JR
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 1:98 POTOMAC DR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3180
Mailing Address - Country:US
Mailing Address - Phone:908-580-9384
Mailing Address - Fax:
Practice Address - Street 1:560 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3848
Practice Address - Country:US
Practice Address - Phone:908-234-9400
Practice Address - Fax:908-234-9477
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00404300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9008-3OtherBC/BS
NJT53839Medicare UPIN