Provider Demographics
NPI:1457847618
Name:POLLAK, ANDREW J (LAC, LMT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:POLLAK
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 ONEAL CIR APT K35
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1471
Mailing Address - Country:US
Mailing Address - Phone:720-541-1032
Mailing Address - Fax:
Practice Address - Street 1:933 ALPINE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3305
Practice Address - Country:US
Practice Address - Phone:720-541-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002347171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist