MEDICARE: DR. WAYNE M POLLER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00208200	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350055367	OTHER	NJ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0023792	OTHER	NJ	GHI

General Provider Information

NPI Number	:	1083699292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE M POLLER DC

Provider Business Mailing Address
First Line	:	136 N WASHINGTON AVENUE
Second Line	:	103
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621
Country	:	US
Telephone Number	:	201-387-2800
Fax Number	:	201-387-2248

Provider Business Practice Location Address
First Line	:	136 N WASHINGTON AVENUE
Second Line	:	103
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621
Country	:	US
Telephone Number	:	201-387-2800
Fax Number	:	201-387-2248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	02/04/2009

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Directions to “ DR. WAYNE M POLLER DC” Practice Location

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