Healthcare Provider Details

I. General information

NPI: 1730622366
Provider Name (Legal Business Name): MATTHEW POLLACK HTTPS://NPPES.CMS.HH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MATTHEW POLLACK D.C.

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9655 S DIXIE HWY 108
PINECREST FL
33156-2813
US

IV. Provider business mailing address

9655 S DIXIE HWY 108
PINECREST FL
33156-2813
US

V. Phone/Fax

Practice location:
  • Phone: 305-667-1618
  • Fax:
Mailing address:
  • Phone: 305-667-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10877
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: