Provider Demographics
NPI:1649343039
Name:POLINO, MICHAEL JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:POLINO
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 1:308 LIPPINCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-4015
Mailing Address - Country:US
Mailing Address - Phone:856-461-3665
Mailing Address - Fax:856-461-3665
Practice Address - Street 1:700 EAST TOWNSHIP LINE ROAD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5733
Practice Address - Country:US
Practice Address - Phone:610-853-2340
Practice Address - Fax:610-853-2343
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005975L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA611624Medicare ID - Type UnspecifiedCHIROPRACTOR