Provider Demographics
NPI:1710064464
Name:POLLACK, ERICA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LYNN
Last Name:POLLACK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:POLLACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3609 BLUE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:24064
Mailing Address - Country:US
Mailing Address - Phone:540-798-9726
Mailing Address - Fax:
Practice Address - Street 1:3609 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:24064-1976
Practice Address - Country:US
Practice Address - Phone:540-977-4611
Practice Address - Fax:540-977-4611
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
222164OtherANTHEM
222164OtherANTHEM
P0879209Medicare PIN