Provider Demographics
NPI:1497110175
Name:DR. STUART POLLACK, D.C., P.A.
Entity Type:Organization
Organization Name:DR. STUART POLLACK, D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:REUBEN
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-321-9520
Mailing Address - Street 1:5301 GULFPORT BLVD S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4947
Mailing Address - Country:US
Mailing Address - Phone:727-321-9520
Mailing Address - Fax:727-321-9520
Practice Address - Street 1:5301 GULFPORT BLVD S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-4947
Practice Address - Country:US
Practice Address - Phone:727-321-9520
Practice Address - Fax:727-321-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381292800Medicaid
FL55618AMedicare UPIN