Provider Demographics
NPI:1720071715
Name:POLIPNICK, JUDITH ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:POLIPNICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13797 HUBER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55302-2213
Mailing Address - Country:US
Mailing Address - Phone:320-558-6772
Mailing Address - Fax:320-558-4558
Practice Address - Street 1:935 CLEARWATER PROFESSIONAL BLDG
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:MN
Practice Address - Zip Code:55320
Practice Address - Country:US
Practice Address - Phone:320-558-6772
Practice Address - Fax:320-558-4558
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT66017Medicare UPIN