Provider Demographics
NPI:1336363910
Name:POLLACK, KIM ELLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:ELLEN
Last Name:POLLACK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 FORT HILL RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4333
Mailing Address - Country:US
Mailing Address - Phone:860-440-6754
Mailing Address - Fax:860-440-6757
Practice Address - Street 1:76 FORT HILL RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4333
Practice Address - Country:US
Practice Address - Phone:860-440-6754
Practice Address - Fax:860-440-6757
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor