Provider Demographics
NPI:1366440893
Name:PITTS, JEFFREY GRAHAM (DC PA)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GRAHAM
Last Name:PITTS
Suffix:
Gender:M
Credentials:DC PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6319
Mailing Address - Country:US
Mailing Address - Phone:352-732-0200
Mailing Address - Fax:352-732-2623
Practice Address - Street 1:801 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6319
Practice Address - Country:US
Practice Address - Phone:352-732-0200
Practice Address - Fax:352-732-2623
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2867111N00000X
GACHIR001194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350053424OtherRAILROAD MEDICARE
FL88199OtherBCBS
FL206247000Medicaid
FL206247000Medicaid
FL88199OtherBCBS