Provider Demographics
NPI:1417063827
Name:PITTMAN, TIMOTHY SHAUN (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SHAUN
Last Name:PITTMAN
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 1:3467 KNICKERBOCKER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6896
Mailing Address - Country:US
Mailing Address - Phone:325-223-9355
Mailing Address - Fax:325-223-9353
Practice Address - Street 1:3467 KNICKERBOCKER RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6896
Practice Address - Country:US
Practice Address - Phone:325-223-9355
Practice Address - Fax:325-223-9353
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A8495Medicare ID - Type UnspecifiedPROVIDER #