Provider Demographics
NPI:1962522888
Name:PITMAN CHIROPRACTIC CLINICS INC.
Entity type:Organization
Organization Name:PITMAN CHIROPRACTIC CLINICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-285-0611
Mailing Address - Street 1:122 E EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-2140
Mailing Address - Country:US
Mailing Address - Phone:815-285-0611
Mailing Address - Fax:815-285-0611
Practice Address - Street 1:122 E EVERETT ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-2140
Practice Address - Country:US
Practice Address - Phone:815-285-0611
Practice Address - Fax:815-285-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL38007928Medicaid
IL630870Medicare ID - Type Unspecified
464537Medicare UPIN