Provider Demographics
NPI:1053557553
Name:.GREGORY W. PASTRICK, D.C. LLC
Entity type:Organization
Organization Name:.GREGORY W. PASTRICK, D.C. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PASTRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-518-7795
Mailing Address - Street 1:184 OVERLOOK BLVD
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1615
Mailing Address - Country:US
Mailing Address - Phone:330-518-7795
Mailing Address - Fax:330-729-1101
Practice Address - Street 1:727 E WESTERN RESERVE RD
Practice Address - Street 2:SUITE B
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-4359
Practice Address - Country:US
Practice Address - Phone:330-519-7795
Practice Address - Fax:330-729-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0182065Medicaid
OH0182065Medicaid
OHU17469Medicare UPIN