Provider Demographics
NPI:1952467631
Name:PITTS FAMILY & SPORTS CHIROPRACTIC CTRS PC
Entity Type:Organization
Organization Name:PITTS FAMILY & SPORTS CHIROPRACTIC CTRS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAMMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-733-4545
Mailing Address - Street 1:515 COURT ST
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-1439
Mailing Address - Country:US
Mailing Address - Phone:712-733-4545
Mailing Address - Fax:712-733-4547
Practice Address - Street 1:515 COURT ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-1439
Practice Address - Country:US
Practice Address - Phone:712-733-4545
Practice Address - Fax:712-733-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05848111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0071522Medicaid
IA0071522Medicaid