Provider Demographics
NPI:1831416148
Name:POLLOCK, ELIZABETH BRANDT (MACOM, LAC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BRANDT
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:MACOM, LAC
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:
Other - Last Name:POLLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MACOM, LAC
Mailing Address - Street 1:3386 SE WAVERLEIGH BLVD
Mailing Address - Street 2:APT. 2
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1978
Mailing Address - Country:US
Mailing Address - Phone:503-753-7494
Mailing Address - Fax:
Practice Address - Street 1:107 SE WASHINGTON ST
Practice Address - Street 2:SUITE #134
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2103
Practice Address - Country:US
Practice Address - Phone:503-236-6633
Practice Address - Fax:503-234-2185
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC151043171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist