Healthcare Provider Details

I. General information

NPI: 1780269498
Provider Name (Legal Business Name): TONI PASTOTNIK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 11/01/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13984 US HIGHWAY 45
BRUCE CROSSING MI
49912
US

IV. Provider business mailing address

16620 NOVAK RD
EWEN MI
49925-9011
US

V. Phone/Fax

Practice location:
  • Phone: 906-458-1437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301401225
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: