Provider Demographics
NPI:1790843639
Name:POLK, JENNIFER DAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DAWN
Last Name:POLK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7332 E CAMELBACK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3443
Mailing Address - Country:US
Mailing Address - Phone:480-941-1555
Mailing Address - Fax:
Practice Address - Street 1:7332 E CAMELBACK RD
Practice Address - Street 2:SUITE A
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3443
Practice Address - Country:US
Practice Address - Phone:480-941-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor