Provider Demographics
NPI:1821354051
Name:POLK, JASON LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LYNN
Last Name:POLK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 E SUNSET WAY
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3813
Mailing Address - Country:US
Mailing Address - Phone:479-790-7909
Mailing Address - Fax:
Practice Address - Street 1:72 E SUNSET WAY
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3813
Practice Address - Country:US
Practice Address - Phone:479-790-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60274742111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition