Provider Demographics
NPI:1750376984
Name:POLZIN, KEVIN L (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:POLZIN
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 1:12360 NE 8TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4801
Mailing Address - Country:US
Mailing Address - Phone:425-999-9633
Mailing Address - Fax:888-899-4360
Practice Address - Street 1:12360 NE 8TH ST
Practice Address - Street 2:SUITE200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4801
Practice Address - Country:US
Practice Address - Phone:425-999-9633
Practice Address - Fax:888-899-4360
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA44814OtherSTATE L & I
WAP01400OtherBLUE CROSS
AB29042Medicare UPIN