MEDICARE: POLATIS CHIROPRACTIC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	111NN1001X	Nutrition Chiropractor
3	208100000X	Physical Medicine & Rehabilitation Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B01616	OTHER	NV	CHIROPRACTIC PHYSICIAN'S BOARD OF NEVADA

General Provider Information

NPI Number	:	1982358651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLATIS CHIROPRACTIC

Provider Business Mailing Address
First Line	:	7035 W ANN RD STE 160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3868
Country	:	US
Telephone Number	:	702-396-0277
Fax Number	:

Provider Business Practice Location Address
First Line	:	7035 W ANN RD STE 160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3868
Country	:	US
Telephone Number	:	702-396-0277
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TODD A POLATIS
Credential	:	DC
Telephone Number	:	702-396-0277

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	02/10/2022

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Directions to “POLATIS CHIROPRACTIC ” Practice Location

Language	Start Address	Practice Location

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