Provider Demographics
NPI:1851374201
Name:POLITIS, GARRETT ALEXANDER (DC)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:ALEXANDER
Last Name:POLITIS
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 1:379 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6803
Mailing Address - Country:US
Mailing Address - Phone:413-441-7101
Mailing Address - Fax:
Practice Address - Street 1:379 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6803
Practice Address - Country:US
Practice Address - Phone:413-443-6337
Practice Address - Fax:413-403-5100
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA350038917OtherPALMETTO GBA
MAY37023OtherBLUE CROSS BLUE SHIELD
MAY37023OtherBLUE CROSS BLUE SHIELD
MAY45499Medicare ID - Type Unspecified