Provider Demographics
NPI:1982881371
Name:POLYNICE, ENEX J (DC)
Entity Type:Individual
Prefix:DR
First Name:ENEX
Middle Name:J
Last Name:POLYNICE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 FALLING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2210
Mailing Address - Country:US
Mailing Address - Phone:314-323-5396
Mailing Address - Fax:267-501-3729
Practice Address - Street 1:2028 FALLING BROOK DR
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2210
Practice Address - Country:US
Practice Address - Phone:314-323-5396
Practice Address - Fax:267-501-3729
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008004318111N00000X
PADC009901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor