Provider Demographics
NPI:1386736809
Name:PITTMON, LEAH JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:JEAN
Last Name:PITTMON
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:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75106-0159
Mailing Address - Country:US
Mailing Address - Phone:972-291-6102
Mailing Address - Fax:972-291-6981
Practice Address - Street 1:907 S MAIN ST
Practice Address - Street 2:SUITE #207
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2385
Practice Address - Country:US
Practice Address - Phone:972-291-6102
Practice Address - Fax:972-291-6981
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R0990OtherBCBS TEXAS
TX177087701Medicaid
TX8C9843Medicare ID - Type Unspecified
TX177087701Medicaid