Provider Demographics
NPI:1164591350
Name:POLLACK, TAMARA L (DIPL AC)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:L
Last Name:POLLACK
Suffix:
Gender:F
Credentials:DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 S CLARKSON ST
Mailing Address - Street 2:SUITE-100
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3909
Mailing Address - Country:US
Mailing Address - Phone:303-789-2330
Mailing Address - Fax:303-789-9155
Practice Address - Street 1:3555 S CLARKSON ST
Practice Address - Street 2:SUITE-100
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3909
Practice Address - Country:US
Practice Address - Phone:303-789-2330
Practice Address - Fax:303-789-9155
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO362171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9511208891Medicare UPIN