Provider Demographics
NPI:1629100177
Name:POLATSCHEK, DONALD PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:PETER
Last Name:POLATSCHEK
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 1:363 E OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4224
Mailing Address - Country:US
Mailing Address - Phone:516-433-2627
Mailing Address - Fax:
Practice Address - Street 1:363 E OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4224
Practice Address - Country:US
Practice Address - Phone:516-433-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002264-1111N00000X
NJMC00178300111N00000X
FLCH6970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT52021Medicare UPIN
NY000X1315100000Medicare ID - Type Unspecified