Healthcare Provider Details

I. General information

NPI: 1841535069
Provider Name (Legal Business Name): PACIFIC COAST MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12360 NE 8TH ST SUITE 200
BELLEVUE WA
98005-4801
US

IV. Provider business mailing address

12360 NE 8TH ST SUITE 200
BELLEVUE WA
98005-4801
US

V. Phone/Fax

Practice location:
  • Phone: 425-999-9633
  • Fax: 888-899-4360
Mailing address:
  • Phone: 425-999-9633
  • Fax: 888-899-4360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEVIN POLZIN
Title or Position: PRESIDENT
Credential:
Phone: 865-590-0376