Provider Demographics
NPI:1841392966
Name:TIM PITTMAN, INC.
Entity type:Organization
Organization Name:TIM PITTMAN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:325-223-9355
Mailing Address - Street 1:3467 KNICKERBOCKER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6896
Mailing Address - Country:US
Mailing Address - Phone:325-223-9355
Mailing Address - Fax:325-223-9353
Practice Address - Street 1:3467 KNICKERBOCKER RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6896
Practice Address - Country:US
Practice Address - Phone:325-223-9355
Practice Address - Fax:325-223-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5685330001332B00000X
TX9576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00423VMedicare UPIN