Healthcare Provider Details

I. General information

NPI: 1053557553
Provider Name (Legal Business Name): .GREGORY W. PASTRICK, D.C. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 E WESTERN RESERVE RD SUITE B
POLAND OH
44514-4359
US

IV. Provider business mailing address

184 OVERLOOK BLVD
STRUTHERS OH
44471-1615
US

V. Phone/Fax

Practice location:
  • Phone: 330-519-7795
  • Fax: 330-729-1101
Mailing address:
  • Phone: 330-518-7795
  • Fax: 330-729-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1371
License Number StateOH

VIII. Authorized Official

Name: GREGORY W PASTRICK
Title or Position: OWNER/MEMBER
Credential: D.C.
Phone: 330-518-7795