Provider Demographics
NPI:1619426251
Name:POLGAR, RANDALL ADAM (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:ADAM
Last Name:POLGAR
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 1:1651 GALISTEO ST
Mailing Address - Street 2:STE 12
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2113
Mailing Address - Country:US
Mailing Address - Phone:408-373-1358
Mailing Address - Fax:
Practice Address - Street 1:2101 SENDA DE DANIEL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-8361
Practice Address - Country:US
Practice Address - Phone:408-373-1358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor