Individual
MARK R PUSTAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
4213 MATTHEWS MINT HILL RD, MATTHEWS, NC 28105-3634
(704) 573-2400
(704) 573-1070
Mailing address
4213 MATTHEWS MINT HILL RD, MATTHEWS, NC 28105-3634
(704) 573-2400
(704) 573-1070
Taxonomy
Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
Primary
1509
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0872M
BLUE CROSS BLUE SHIELD
NC
05
—
5900047
—
NC
Enumeration date
06/15/2005
Last updated
06/28/2011
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