Healthcare Provider Details

I. General information

NPI: 1952491920
Provider Name (Legal Business Name): GREGORY W PASTRICK DC LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/14/2007
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
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: