Provider Demographics
NPI:1215280649
Name:POLLARD, JOHN KINGSLEY III (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KINGSLEY
Last Name:POLLARD
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 ALTA SIERRA DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949
Mailing Address - Country:US
Mailing Address - Phone:805-241-4194
Mailing Address - Fax:805-493-1854
Practice Address - Street 1:10110 ALTA SIERRA DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949
Practice Address - Country:US
Practice Address - Phone:530-272-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11502OtherCALIF STATE CHIROPRACTIC LICENSE