Provider Demographics
NPI:1982817813
Name:POLCYN, JONATHAN MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MARK
Last Name:POLCYN
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 1:2155 CITY GATE LN STE 123
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-7733
Mailing Address - Country:US
Mailing Address - Phone:331-249-3999
Mailing Address - Fax:331-249-4029
Practice Address - Street 1:2155 CITY GATE LN STE 123
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-7733
Practice Address - Country:US
Practice Address - Phone:331-249-3999
Practice Address - Fax:815-717-8416
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor