Provider Demographics
NPI:1649719626
Name:PASTOR, THOMAS IV (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:PASTOR
Suffix:IV
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 1:2677 INNSBRUCK DR STE D
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-9300
Mailing Address - Country:US
Mailing Address - Phone:651-314-3739
Mailing Address - Fax:651-330-6692
Practice Address - Street 1:2677 INNSBRUCK DR STE D
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-9300
Practice Address - Country:US
Practice Address - Phone:651-314-3739
Practice Address - Fax:651-330-6692
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor