Provider Demographics
NPI:1760475438
Name:POLZIN CHIROPRACTIC INC PS
Entity Type:Organization
Organization Name:POLZIN CHIROPRACTIC INC PS
Other - Org Name:INNOVATIVE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLZIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-338-1555
Mailing Address - Street 1:1700 132ND ST SE
Mailing Address - Street 2:STE L
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012
Mailing Address - Country:US
Mailing Address - Phone:425-338-1555
Mailing Address - Fax:425-338-0765
Practice Address - Street 1:1700 132ND ST SE
Practice Address - Street 2:STE L
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-338-1555
Practice Address - Fax:425-338-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB29041Medicare ID - Type Unspecified