Provider Demographics
NPI:1114085453
Name:PITTS, BOBBY SHAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:SHAWN
Last Name:PITTS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 WARREN AVE.
Mailing Address - Street 2:PO BOX 54
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375
Mailing Address - Country:US
Mailing Address - Phone:731-645-3850
Mailing Address - Fax:731-645-3851
Practice Address - Street 1:134 WARREN AVE.
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375
Practice Address - Country:US
Practice Address - Phone:731-645-3850
Practice Address - Fax:731-645-3851
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3675861Medicaid
TNU32512Medicare UPIN
TN3675861Medicare ID - Type Unspecified