Provider Demographics
NPI:1740300458
Name:PITTMAN FAMILY CHIROPRACTIC, INC
Entity type:Organization
Organization Name:PITTMAN FAMILY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:W
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, BSC
Authorized Official - Phone:425-457-0470
Mailing Address - Street 1:13028 INTERURBAN AVE S
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3340
Mailing Address - Country:US
Mailing Address - Phone:206-957-7950
Mailing Address - Fax:206-957-7952
Practice Address - Street 1:13028 INTERURBAN AVE S
Practice Address - Street 2:SUITE 106
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3340
Practice Address - Country:US
Practice Address - Phone:206-957-7950
Practice Address - Fax:206-957-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2006073131740267247OtherHEALTHWAYS WHOLEHEALTH