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General NPI Number Information
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NPI Number | 1619426251
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Entity Type | Individual
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Provider Name | RANDALL ADAM POLGAR D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 01/08/2017
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Provider Practice Location Address
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Address Line | 2101 SENDA DE DANIEL
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City | SANTA FE
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State | NM
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Zip | 87501-8361
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Country | US
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Telephone | 408-373-1358
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Fax |
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Provider Business Mailing Address
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Address Line | 1651 GALISTEO ST STE 12
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City | SANTA FE
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State | NM
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Zip | 87505-2113
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Country | US
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Telephone | 408-373-1358
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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 | 2146
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License Number State | NM
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