Healthcare Provider Details

I. General information

NPI: 1336894716
Provider Name (Legal Business Name): SAVANNAH POLSON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 E HIGHWAY 37
TUTTLE OK
73089-8582
US

IV. Provider business mailing address

PO BOX 479
TUTTLE OK
73089-0479
US

V. Phone/Fax

Practice location:
  • Phone: 405-392-5640
  • Fax:
Mailing address:
  • Phone: 405-392-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4466
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: