Provider Demographics
NPI:1548335763
Name:POLANSKI, MIROSLAW ADAM (DC)
Entity type:Individual
Prefix:MR
First Name:MIROSLAW
Middle Name:ADAM
Last Name:POLANSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 COURT STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231
Mailing Address - Country:US
Mailing Address - Phone:718-243-2257
Mailing Address - Fax:718-243-2258
Practice Address - Street 1:476 COURT STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231
Practice Address - Country:US
Practice Address - Phone:718-243-2257
Practice Address - Fax:718-243-2258
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010819-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V01948Medicare UPIN
X7N191Medicare PIN