MEDICARE: BRIAN POLVI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4206	CO

General Provider Information

NPI Number	:	1790922516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN POLVI

Provider Business Mailing Address
First Line	:	3425 AUSTIN BLUFFS PKWY STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5701
Country	:	US
Telephone Number	:	719-533-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 AUSTIN BLUFFS PKWY STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5701
Country	:	US
Telephone Number	:	719-533-1000
Fax Number	:	719-599-5817

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	01/31/2024

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Directions to “ BRIAN POLVI ” Practice Location

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