=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831375013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POLLACK CHIROPRACTIC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2008
-----------------------------------------------------
Last Update Date | 01/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 E COAST HWY #260
-----------------------------------------------------
City | CORONA DEL MAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92625-1931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-721-0606
-----------------------------------------------------
Fax | 949-945-1425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2121 E COAST HWY #260
-----------------------------------------------------
City | CORONA DEL MAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92625-1931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-721-0606
-----------------------------------------------------
Fax | 949-945-1425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. MARK POLLACK
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 949-721-0606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC22437
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------