=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851695332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WENDY POLLOCK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2010
-----------------------------------------------------
Last Update Date | 12/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 SAINT JOHN ST STE 137
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04102-3024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-774-9666
-----------------------------------------------------
Fax | 207-839-2197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 SAINT JOHN ST STE 137
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04102-3024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-774-9666
-----------------------------------------------------
Fax | 207-839-2197
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | SUSAN MCKINLEY
-----------------------------------------------------
Credential | BS
-----------------------------------------------------
Telephone | 207-939-7072
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | ME620
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------