Provider Demographics
NPI:1306129044
Name:HASTIE ISAENKO, PAMELA JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JEAN
Last Name:HASTIE ISAENKO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 STATE FARM RD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5307
Mailing Address - Country:US
Mailing Address - Phone:828-355-9858
Mailing Address - Fax:828-355-9859
Practice Address - Street 1:838 STATE FARM RD
Practice Address - Street 2:UNIT 1
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5307
Practice Address - Country:US
Practice Address - Phone:828-355-9858
Practice Address - Fax:828-355-9859
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor