Provider Demographics
NPI:1043516065
Name:POLAK, PAUL P (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:P
Last Name:POLAK
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:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-0027
Mailing Address - Country:US
Mailing Address - Phone:412-532-8552
Mailing Address - Fax:724-483-0318
Practice Address - Street 1:4660 STATE ROUTE 51 STE 4
Practice Address - Street 2:
Practice Address - City:ROSTRAVER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15012-4330
Practice Address - Country:US
Practice Address - Phone:412-532-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026003000001Medicaid