Provider Demographics
NPI:1508137654
Name:POLLOCK, LARA (MSOM, DIPLOM, DOM)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:MSOM, DIPLOM, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16666 SW 154TH TER
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:KS
Mailing Address - Zip Code:67133-8339
Mailing Address - Country:US
Mailing Address - Phone:316-619-2777
Mailing Address - Fax:
Practice Address - Street 1:345 N RIVERVIEW ST
Practice Address - Street 2:SUITE 400
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4200
Practice Address - Country:US
Practice Address - Phone:316-619-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1034171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist