Provider Demographics
NPI:1487945804
Name:POLZIEN, LEAH (DC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:POLZIEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:HALLQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LAURIUM
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2067
Mailing Address - Country:US
Mailing Address - Phone:906-337-1200
Mailing Address - Fax:906-337-1201
Practice Address - Street 1:80 1ST ST
Practice Address - Street 2:
Practice Address - City:LAURIUM
Practice Address - State:MI
Practice Address - Zip Code:49913-2067
Practice Address - Country:US
Practice Address - Phone:906-337-1200
Practice Address - Fax:906-337-1201
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor