Healthcare Provider Details

I. General information

NPI: 1578151742
Provider Name (Legal Business Name): PACIFIC COAST INTEGRATED MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 425-922-2055
  • Fax: 888-899-4360
Mailing address:
  • Phone: 425-922-2055
  • Fax: 888-899-4360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN LARRY POLZIN
Title or Position: MEMBER
Credential: DC
Phone: 425-922-2055