Provider Demographics
NPI:1710027651
Name:POLARIS FAMILY AND SPORT CHIROPRACTIC INC
Entity Type:Organization
Organization Name:POLARIS FAMILY AND SPORT CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-846-2225
Mailing Address - Street 1:9383 S OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8448
Mailing Address - Country:US
Mailing Address - Phone:614-846-2225
Mailing Address - Fax:614-846-8300
Practice Address - Street 1:9383 S OLD STATE RD
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8448
Practice Address - Country:US
Practice Address - Phone:614-846-2225
Practice Address - Fax:614-846-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU47930Medicare UPIN
OHPO9340461Medicare PIN