Provider Demographics
NPI:1659477289
Name:POLLOCK, WAYNE L (DC)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:L
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 THERESA DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320
Mailing Address - Country:US
Mailing Address - Phone:805-375-2778
Mailing Address - Fax:
Practice Address - Street 1:2904 THERESA DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320
Practice Address - Country:US
Practice Address - Phone:805-375-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659477289OtherNATIONAL PROVIDER IDENTIF
DC18593Medicare PIN
1659477289OtherNATIONAL PROVIDER IDENTIF