Provider Demographics
NPI:1134635980
Name:PESTA, RAMICA (DC)
Entity Type:Individual
Prefix:
First Name:RAMICA
Middle Name:
Last Name:PESTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 GRATIOT BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1497
Mailing Address - Country:US
Mailing Address - Phone:810-294-4847
Mailing Address - Fax:810-824-3346
Practice Address - Street 1:2845 GRATIOT BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1497
Practice Address - Country:US
Practice Address - Phone:810-294-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013106111N00000X
MI2301010606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor