Provider Demographics
NPI:1225199425
Name:HASTIE, PAUL MARK (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MARK
Last Name:HASTIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-2946
Mailing Address - Country:US
Mailing Address - Phone:610-497-2779
Mailing Address - Fax:
Practice Address - Street 1:2830 CONCORD RD
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-2946
Practice Address - Country:US
Practice Address - Phone:610-497-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001465L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor