Individual
JEFFERY BLAKE PITMAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1201 BIRCH ST, BENTON, KY 42025-1549
(270) 527-5898
(270) 527-5898
Mailing address
1201 BIRCH ST, BENTON, KY 42025-1549
(270) 527-5898
(270) 527-5898
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4172
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000050197
ANTHEM
KY
01
—
607460
ACN
KY
05
—
85002517
—
KY
Enumeration date
07/31/2005
Last updated
07/08/2007
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