Provider Demographics
NPI:1952535965
Name:DR THOMAS POLUCKI UPPER CERVICAL CHIROPRACTIC INC
Entity Type:Organization
Organization Name:DR THOMAS POLUCKI UPPER CERVICAL CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:POLUCKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-753-9340
Mailing Address - Street 1:25050 PEACHLAND AVE
Mailing Address - Street 2:#105
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2523
Mailing Address - Country:US
Mailing Address - Phone:661-753-9340
Mailing Address - Fax:661-753-9341
Practice Address - Street 1:25050 PEACHLAND AVE
Practice Address - Street 2:#105
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2523
Practice Address - Country:US
Practice Address - Phone:661-753-9340
Practice Address - Fax:661-753-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty