Individual
MIKE M POULIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2465 CENTREVILLE RD STE J18, HERNDON, VA 20171-3026
(703) 561-0600
(703) 561-0601
Mailing address
2465 CENTREVILLE RD STE J18, HERNDON, VA 20171-3026
(703) 561-0600
(703) 561-0601
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104001170
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
211741
ANTHEM
VA
01
—
F610-0001
CAREFIRST BLUE CROSS
VA
Enumeration date
11/08/2006
Last updated
07/08/2007
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