Provider Demographics
NPI:1023093127
Name:POLLOCK, WENDY (DC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:POLLOCK
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:PO BOX 8406
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-8406
Mailing Address - Country:US
Mailing Address - Phone:207-370-8330
Mailing Address - Fax:
Practice Address - Street 1:83 INDIA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4210
Practice Address - Country:US
Practice Address - Phone:207-370-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
200941097OtherTAX ID
CR620OtherLICENSE
M51022OtherCIGNA
ME114150000Medicaid
4414946OtherAETNA
MNT021OtherHARVARD PILGRIM
022665OtherANTHEM
114150000OtherMAINE CARE
MM0377Medicare ID - Type Unspecified
022665OtherANTHEM