Provider Demographics
NPI:1124139274
Name:BLUFFTON FAMILY CHIROPRACTIC P A
Entity type:Organization
Organization Name:BLUFFTON FAMILY CHIROPRACTIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:AITA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-706-3472
Mailing Address - Street 1:80 BAYLOR DR STE 114
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8905
Mailing Address - Country:US
Mailing Address - Phone:843-706-3472
Mailing Address - Fax:843-706-3473
Practice Address - Street 1:80 BAYLOR DR STE 114
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8905
Practice Address - Country:US
Practice Address - Phone:843-706-3472
Practice Address - Fax:843-706-3473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNPI 1679520506OtherDR. JEFFREY L. AITA NPI
SCGCH413Medicaid
SCNPI 1225081086OtherDR. KATHLEEN HOUPT NPI
SCGCH413Medicaid
SCT643677556Medicare ID - Type Unspecified
SCT64367Medicare UPIN
SCAA05967556Medicare ID - Type Unspecified