Provider Demographics
NPI:1679520506
Name:AITA, JEFFREY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LYNN
Last Name:AITA
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 1:80 BAYLOR DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8902
Mailing Address - Country:US
Mailing Address - Phone:843-706-3472
Mailing Address - Fax:843-706-3473
Practice Address - Street 1:80 BAYLOR DR
Practice Address - Street 2:SUITE 114
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8902
Practice Address - Country:US
Practice Address - Phone:843-706-3472
Practice Address - Fax:843-706-3473
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T643677556Medicare ID - Type Unspecified
T64367Medicare UPIN