Provider Demographics
NPI:1801969449
Name:POLK, CAREN M (DC)
Entity type:Individual
Prefix:MRS
First Name:CAREN
Middle Name:M
Last Name:POLK
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 1:916 CAPE CORAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9014
Mailing Address - Country:US
Mailing Address - Phone:239-542-1422
Mailing Address - Fax:239-542-9688
Practice Address - Street 1:916 CAPE CORAL PKWY E
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9014
Practice Address - Country:US
Practice Address - Phone:239-542-1422
Practice Address - Fax:239-542-9688
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH7731OtherLICENSE NUMBER