Individual
GREGORY R POLOVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
915 W SPRESSER ST, TAYLORVILLE, IL 62568-1831
(217) 824-6222
(217) 824-5511
Mailing address
823 MESA VERDE CT, TAYLORVILLE, IL 62568-9103
(217) 824-6222
(217) 824-5511
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-004196
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8782001
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/05/2006
Last updated
05/26/2015
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