| 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 |
|---|---|
| Gender | Male |
| Speciality | Chiropractic |
| Experience | 4 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 |
|---|---|
| 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 |
|---|---|
| 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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