Dr Bradley Jack Polen, DC | |
203 S 6th St, Wood River, IL 62095-2345 | |
(618) 254-9355 | |
(618) 254-9351 |
Full Name | Dr Bradley Jack Polen |
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Gender | Male |
Speciality | Chiropractic |
Experience | 3 Years |
Location | 203 S 6th St, Wood River, Illinois |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1043894165 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 2021016090 (Missouri) | Secondary |
111N00000X | Chiropractor | 038.013756 (Illinois) | Primary |
Provider Name | Superior Chiropractic & Rehab |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1033840442 PECOS PAC ID: 7113391863 Enrollment ID: O20230320000938 |
Mailing Address | Practice Location Address |
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Dr Bradley Jack Polen, DC 203 S 6th St, Wood River, IL 62095-2345 Ph: (618) 254-9355 | Dr Bradley Jack Polen, DC 203 S 6th St, Wood River, IL 62095-2345 Ph: (618) 254-9355 |
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