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General NPI Number Information
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NPI Number | 1922383181
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Entity Type | Organization
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Legal Business Name | PITKIN FAMILY CHIROPRACTIC INC.
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 101 WEST SECOND STREET SUITE 207
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City | DIXON
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State | IL
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Zip | 61021-0648
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Country | US
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Telephone | 815-288-7911
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Fax | 815-288-6387
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Provider Business Mailing Address
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Address Line | 101 WEST SECOND STREET SUITE 207
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City | DIXON
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State | IL
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Zip | 61021-0648
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Country | US
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Telephone | 815-288-7911
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Fax | 815-288-6387
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH WAYNE PITKIN
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Credential | D.C.
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Telephone | 815-288-7911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038007454
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License Number State | IL
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