Provider Demographics
NPI:1871816777
Name:PASTUCH, SEAN JONATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:JONATHAN
Last Name:PASTUCH
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 1:131 W OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4007
Mailing Address - Country:US
Mailing Address - Phone:516-822-1900
Mailing Address - Fax:
Practice Address - Street 1:131 W OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4007
Practice Address - Country:US
Practice Address - Phone:516-822-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor