Provider Demographics
NPI:1285754036
Name:POLCHINSKI CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:POLCHINSKI CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:POLCHINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:BSRT, DC
Authorized Official - Phone:254-634-6688
Mailing Address - Street 1:PO BOX 4327
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-4327
Mailing Address - Country:US
Mailing Address - Phone:254-634-6688
Mailing Address - Fax:254-634-9744
Practice Address - Street 1:412 E AVENUE G
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-6237
Practice Address - Country:US
Practice Address - Phone:254-634-6688
Practice Address - Fax:254-634-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty