Provider Demographics
NPI:1417030628
Name:POLLACK, KRIS (DC)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:POLLACK
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 1:4309 OAKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3418
Mailing Address - Country:US
Mailing Address - Phone:503-635-4656
Mailing Address - Fax:503-635-4281
Practice Address - Street 1:4309 OAKRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3418
Practice Address - Country:US
Practice Address - Phone:503-635-4656
Practice Address - Fax:503-635-4281
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU84629Medicare UPIN
ORR135566Medicare ID - Type Unspecified