Healthcare Provider Details

I. General information

NPI: 1497110175
Provider Name (Legal Business Name): DR. STUART POLLACK, D.C., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 GULFPORT BLVD S
GULFPORT FL
33707-4947
US

IV. Provider business mailing address

5301 GULFPORT BLVD S
GULFPORT FL
33707-4947
US

V. Phone/Fax

Practice location:
  • Phone: 727-321-9520
  • Fax: 727-321-9520
Mailing address:
  • Phone: 727-321-9520
  • Fax: 727-321-9520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. STUART REUBEN POLLACK
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: D.C.
Phone: 727-321-9520