Provider Demographics
NPI:1235214727
Name:PITMAN, GREGORY M (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:PITMAN
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 1:8241 CORNELL RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2283
Mailing Address - Country:US
Mailing Address - Phone:513-777-0024
Mailing Address - Fax:513-777-0036
Practice Address - Street 1:8241 CORNELL RD
Practice Address - Street 2:SUITE 220
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2235
Practice Address - Country:US
Practice Address - Phone:513-777-0024
Practice Address - Fax:513-777-0036
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0579521Medicare PIN