Healthcare Provider Details

I. General information

NPI: 1952467631
Provider Name (Legal Business Name): PITTS FAMILY & SPORTS CHIROPRACTIC CTRS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 COURT ST
HARLAN IA
51537-1439
US

IV. Provider business mailing address

515 COURT ST
HARLAN IA
51537-1439
US

V. Phone/Fax

Practice location:
  • Phone: 712-733-4545
  • Fax: 712-733-4547
Mailing address:
  • Phone: 712-733-4545
  • Fax: 712-733-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA05848
License Number StateIA

VIII. Authorized Official

Name: MRS. JAMIE BRAMMAN
Title or Position: CHIROPRACTIC ASSISTANT
Credential:
Phone: 712-733-4545