Healthcare Provider Details

I. General information

NPI: 1881776102
Provider Name (Legal Business Name): AARON L POLZIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 STUART AVE
ALAMOSA CO
81101-2269
US

IV. Provider business mailing address

106 BLANCA AVE
ALAMOSA CO
81101-2340
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-3000
  • Fax: 719-589-8112
Mailing address:
  • Phone: 719-589-3000
  • Fax: 719-589-8112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5545
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: