Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC005975L | PA |
NPI | 1649343039 |
---|---|
Provider Name | Dr. Michael Joseph Polino |
First Address | Riverside, NJ 08075-4015 |
Second Address | Havertown, PA 19083-5733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 13/11/2007 |