Provider Demographics
NPI:1144656448
Name:POLITOWSKI, JESSE DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:DANIEL
Last Name:POLITOWSKI
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 1:8005 MACKENZIE ROAD
Mailing Address - Street 2:
Mailing Address - City:AFFTON
Mailing Address - State:MO
Mailing Address - Zip Code:63123-3518
Mailing Address - Country:US
Mailing Address - Phone:314-353-4500
Mailing Address - Fax:
Practice Address - Street 1:8005 MACKENZIE ROAD
Practice Address - Street 2:
Practice Address - City:AFFTON
Practice Address - State:MO
Practice Address - Zip Code:63123-3518
Practice Address - Country:US
Practice Address - Phone:314-353-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013033420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor