Provider Demographics
NPI:1821389370
Name:STEVEN M PITTSON CHIROPRACTIC INC
Entity Type:Organization
Organization Name:STEVEN M PITTSON CHIROPRACTIC INC
Other - Org Name:PATTERSON CHIROPRACTIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PITTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-892-2915
Mailing Address - Street 1:420 W LAS PALMAS AVE
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-2542
Mailing Address - Country:US
Mailing Address - Phone:209-892-2915
Mailing Address - Fax:209-892-2938
Practice Address - Street 1:420 W LAS PALMAS AVE
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-2542
Practice Address - Country:US
Practice Address - Phone:209-892-2915
Practice Address - Fax:209-892-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC017532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT06499Medicare UPIN