Provider Demographics
NPI:1669677100
Name:POLLY'S CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:POLLY'S CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEDIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-768-1122
Mailing Address - Street 1:5810 S HIGHWAY 95
Mailing Address - Street 2:STE. 2
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6076
Mailing Address - Country:US
Mailing Address - Phone:928-768-1122
Mailing Address - Fax:928-768-4754
Practice Address - Street 1:5810 S HIGHWAY 95
Practice Address - Street 2:STE. 2
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86426-6076
Practice Address - Country:US
Practice Address - Phone:928-768-1122
Practice Address - Fax:928-768-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115940Medicare PIN