Provider Demographics
NPI:1770598476
Name:POLI, MARC ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ERIC
Last Name:POLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:114 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4538
Mailing Address - Country:US
Mailing Address - Phone:714-883-2693
Mailing Address - Fax:419-828-2389
Practice Address - Street 1:7212 ORANGETHORPE AVE
Practice Address - Street 2:SUITE 9-B
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3341
Practice Address - Country:US
Practice Address - Phone:714-883-2693
Practice Address - Fax:419-828-2389
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19574111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0195740Medicare UPIN