Provider Demographics
NPI:1720858939
Name:POLASCHEK, KIERSTEN LEE (DC)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:LEE
Last Name:POLASCHEK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 THOMAS CENTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-5406
Mailing Address - Country:US
Mailing Address - Phone:651-209-9710
Mailing Address - Fax:
Practice Address - Street 1:1590 THOMAS CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-5406
Practice Address - Country:US
Practice Address - Phone:651-209-9710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty