Provider Demographics
NPI:1780454231
Name:POLAK, JENNIFER NICKI (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICKI
Last Name:POLAK
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 1:1102 W INDIANTOWN RD STE 11
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6813
Mailing Address - Country:US
Mailing Address - Phone:561-741-1316
Mailing Address - Fax:561-741-1375
Practice Address - Street 1:1102 W INDIANTOWN RD STE 11
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6813
Practice Address - Country:US
Practice Address - Phone:561-741-1316
Practice Address - Fax:561-741-1375
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty