Provider Demographics
NPI:1013103092
Name:POLADIAN CHIROPRACTIC
Entity Type:Organization
Organization Name:POLADIAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:POLADAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-675-1211
Mailing Address - Street 1:501 W YOSEMITE AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4520
Mailing Address - Country:US
Mailing Address - Phone:559-675-1211
Mailing Address - Fax:559-675-1212
Practice Address - Street 1:501 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4520
Practice Address - Country:US
Practice Address - Phone:559-675-1211
Practice Address - Fax:559-675-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0115011Medicaid