Basic Information
| Provider Information | |||||||||
| NPI: | 1851695332 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WENDY POLLOCK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 SAINT JOHN ST STE 137 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041023024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077749666 | ||||||||
| FaxNumber: | 2078392197 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 SAINT JOHN ST STE 137 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041023024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077749666 | ||||||||
| FaxNumber: | 2078392197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2010 | ||||||||
| LastUpdateDate: | 12/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | MCKINLEY | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2079397072 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | ME620 | ME | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.