Healthcare Provider Details

I. General information

NPI: 1710027651
Provider Name (Legal Business Name): POLARIS FAMILY AND SPORT CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9383 S OLD STATE RD
LEWIS CENTER OH
43035-8448
US

IV. Provider business mailing address

9383 S OLD STATE RD
LEWIS CENTER OH
43035-8448
US

V. Phone/Fax

Practice location:
  • Phone: 614-846-2225
  • Fax: 614-846-8300
Mailing address:
  • Phone: 614-846-2225
  • Fax: 614-846-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDALL WILLIAM HUFFER
Title or Position: OWNER
Credential: D.C
Phone: 614-846-2225