Provider Demographics
NPI:1972722460
Name:ELISE BITTRICH DC PC
Entity Type:Organization
Organization Name:ELISE BITTRICH DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PERFETTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-572-2178
Mailing Address - Street 1:5040 W WARBLER ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-9313
Mailing Address - Country:US
Mailing Address - Phone:520-572-2178
Mailing Address - Fax:
Practice Address - Street 1:540 W PRINCE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3462
Practice Address - Country:US
Practice Address - Phone:520-888-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ107484Medicare PIN