Provider Demographics
NPI:1649365461
Name:POLLEY, DAVID WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:POLLEY
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 1:4136 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0133670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T04993Medicare UPIN