Provider Demographics
NPI:1629499728
Name:J POL WELLNESS LLC
Entity Type:Organization
Organization Name:J POL WELLNESS LLC
Other - Org Name:SPINE AND JOINT CENTER OF AFFTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:POLITOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-353-4500
Mailing Address - Street 1:8005 MACKENZIE RD
Mailing Address - Street 2:
Mailing Address - City:AFFTON
Mailing Address - State:MO
Mailing Address - Zip Code:63123-3518
Mailing Address - Country:US
Mailing Address - Phone:314-353-4500
Mailing Address - Fax:
Practice Address - Street 1:8005 MACKENZIE RD
Practice Address - Street 2:
Practice Address - City:AFFTON
Practice Address - State:MO
Practice Address - Zip Code:63123-3518
Practice Address - Country:US
Practice Address - Phone:314-353-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013033420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty