Healthcare Provider Details

I. General information

NPI: 1649343039
Provider Name (Legal Business Name): MICHAEL JOSEPH POLINO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 EAST TOWNSHIP LINE ROAD
HAVERTOWN PA
19083-5733
US

IV. Provider business mailing address

308 LIPPINCOTT AVE
RIVERSIDE NJ
08075-4015
US

V. Phone/Fax

Practice location:
  • Phone: 610-853-2340
  • Fax: 610-853-2343
Mailing address:
  • Phone: 856-461-3665
  • Fax: 856-461-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC005975L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: