Provider Demographics
NPI:1861818213
Name:DAVID POLLEY CHIROPRACTIC PC INC
Entity Type:Organization
Organization Name:DAVID POLLEY CHIROPRACTIC PC INC
Other - Org Name:FAIR OAKS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:POLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-965-4125
Mailing Address - Street 1:4136 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7413
Mailing Address - Country:US
Mailing Address - Phone:916-965-4125
Mailing Address - Fax:916-965-4129
Practice Address - Street 1:4136 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7413
Practice Address - Country:US
Practice Address - Phone:916-965-4125
Practice Address - Fax:916-965-4129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT04993Medicare UPIN
CADC0133670Medicare PIN