Provider Demographics
NPI:1518753904
Name:POLK, JEREMIAH (DC)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:POLK
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 1:1605 WESTGATE CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8397
Mailing Address - Country:US
Mailing Address - Phone:615-813-5611
Mailing Address - Fax:
Practice Address - Street 1:1605 WESTGATE CIR STE 101
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8397
Practice Address - Country:US
Practice Address - Phone:615-813-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor