Provider Demographics
NPI:1790948214
Name:STEPHANIE POLLOCK, INC.
Entity Type:Organization
Organization Name:STEPHANIE POLLOCK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GREENREICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-854-7700
Mailing Address - Street 1:24837 104TH AVE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6800
Mailing Address - Country:US
Mailing Address - Phone:253-854-7700
Mailing Address - Fax:253-854-2986
Practice Address - Street 1:24837 104TH AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6800
Practice Address - Country:US
Practice Address - Phone:253-854-7700
Practice Address - Fax:253-854-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB37372Medicare PIN