Provider Demographics
NPI:1922283555
Name:LEAH COMBS PITTMON DC
Entity Type:Organization
Organization Name:LEAH COMBS PITTMON DC
Other - Org Name:PITTMON FAMILY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PITTMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-291-6102
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75106-0159
Mailing Address - Country:US
Mailing Address - Phone:972-291-6102
Mailing Address - Fax:972-291-6981
Practice Address - Street 1:907 S MAIN ST
Practice Address - Street 2:SUITE #207
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2385
Practice Address - Country:US
Practice Address - Phone:972-291-6102
Practice Address - Fax:972-291-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX668744OtherUHC
TX177086901Medicaid
TX09MAOtherBCBS GROUP
TXV03052Medicare UPIN
TX177086901Medicaid