Healthcare Provider Details

I. General information

NPI: 1356054357
Provider Name (Legal Business Name): MADDIE POLASKI DC, CCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADDIE LINDSAY DC, CCSP

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 06/15/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SW 6TH ST
PENDLETON OR
97801-2026
US

IV. Provider business mailing address

424 SW 6TH ST
PENDLETON OR
97801-2026
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-6880
  • Fax:
Mailing address:
  • Phone: 541-561-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6276
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: