Provider Demographics
NPI:1518118751
Name:PITCHER, MARK JANES (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JANES
Last Name:PITCHER
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:PO BOX 2637
Mailing Address - Street 2:0105 EDWARDS VILLAGE BLVD A203
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-2637
Mailing Address - Country:US
Mailing Address - Phone:970-926-4600
Mailing Address - Fax:970-926-4602
Practice Address - Street 1:0105 EDWARDS VILLAGE BLVD A203
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-2637
Practice Address - Country:US
Practice Address - Phone:970-926-4600
Practice Address - Fax:970-926-4602
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO303536Medicare PIN