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General NPI Number Information
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NPI Number | 1457955882
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Entity Type | Individual
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Provider Name | JENNIFER POLANCO
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Gender | Female
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2607 HERWALD ST
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City | SARASOTA
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State | FL
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Zip | 34231-5113
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Country | US
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Telephone | 941-323-9227
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Fax |
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Provider Business Mailing Address
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Address Line | 2607 HERWALD ST
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City | SARASOTA
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State | FL
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Zip | 34231-5113
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Country | US
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Telephone | 941-323-9227
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH15602
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA63328
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License Number State | FL
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