Healthcare Provider Details

I. General information

NPI: 1487885331
Provider Name (Legal Business Name): JUSTIN B. POLLACK N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507C MAIN ST. BOX 4236
FRISCO CO
80443-4236
US

IV. Provider business mailing address

507C MAIN ST. PO BOX 4236
FRISCO CO
80443-4236
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-1300
  • Fax: 970-668-1301
Mailing address:
  • Phone: 970-668-1300
  • Fax: 970-668-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1011
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: