Provider Demographics
NPI:1609861335
Name:PUSTILNIK, MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:PUSTILNIK
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:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:AULT
Mailing Address - State:CO
Mailing Address - Zip Code:80610-0249
Mailing Address - Country:US
Mailing Address - Phone:970-834-2888
Mailing Address - Fax:970-834-2775
Practice Address - Street 1:120 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:AULT
Practice Address - State:CO
Practice Address - Zip Code:80610
Practice Address - Country:US
Practice Address - Phone:970-834-2888
Practice Address - Fax:970-834-2775
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor