Provider Demographics
NPI:1770674939
Name:PITTSBURG, LEE J (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:J
Last Name:PITTSBURG
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 1:245 BLOOMFIELD DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7789
Mailing Address - Country:US
Mailing Address - Phone:717-569-5075
Mailing Address - Fax:717-569-5030
Practice Address - Street 1:245 BLOOMFIELD DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7789
Practice Address - Country:US
Practice Address - Phone:717-569-5075
Practice Address - Fax:717-569-5030
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002956L111N00000X
NJ38MC00319200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01809801OtherCHIROPRACTOR
PA2265813OtherAETNA CHIROPRACTOR
PAPI428543Medicare ID - Type UnspecifiedCHIROPRACTOR
PA2265813OtherAETNA CHIROPRACTOR