Provider Demographics
NPI:1952491920
Name:PASTRICK, GREGORY W (DC LLC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:W
Last Name:PASTRICK
Suffix:
Gender:M
Credentials:DC LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 OVERLOOK BLVD
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471
Mailing Address - Country:US
Mailing Address - Phone:330-518-7795
Mailing Address - Fax:
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:330-518-7795
Practice Address - Fax:330-729-1101
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0182065Medicaid
OH0182065Medicaid
OHPA0689892Medicare ID - Type Unspecified