Provider Demographics
NPI:1578151742
Name:PACIFIC COAST INTEGRATED MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:PACIFIC COAST INTEGRATED MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:POLZIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-922-2055
Mailing Address - Street 1:12360 NE 8TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4801
Mailing Address - Country:US
Mailing Address - Phone:425-922-2055
Mailing Address - Fax:888-899-4360
Practice Address - Street 1:12360 NE 8TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4801
Practice Address - Country:US
Practice Address - Phone:425-922-2055
Practice Address - Fax:888-899-4360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty