Individual
DR. MARY KAY POLSEMEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
3150 CROW CANYON PL, STE 120, SAN RAMON, CA 94583-1778
(925) 830-8635
(925) 830-8652
Mailing address
3150 CROW CANYON PL, STE 120, SAN RAMON, CA 94583-1778
(925) 830-8635
(925) 830-8652
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
23832
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CY272A
MEDICARE PTAN
CA
Enumeration date
06/08/2005
Last updated
07/09/2010
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