Active NPI
Bobby Shawn Pitts, DC
- Chiropractor
- Selmer, TN
National Provider Identifier
1114085453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 761
- Practice address
- 134 Warren Ave.
Selmer, TN 38375 - Phone
- (731) 645-3850
- Fax
- (731) 645-3851
- NPI assigned
- Dec 5, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 761 | TN | Primary |
Addresses
Primary practice location
134 Warren Ave.
Selmer, TN 38375
Mailing address
134 Warren Ave.
PO Box 54
Selmer, TN 38375
Phone (731) 645-3850
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3675861 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111109000473 | TN | Practitioner - Chiropractic | 7214100155 | Practice locations: Selmer, TN |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 761 | TN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114085453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "134 WARREN AVE.",
"address_2": "PO BOX 54",
"city": "SELMER",
"state": "TN",
"postal_code": "38375",
"telephone_number": "731-645-3850",
"fax_number": "731-645-3851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "134 WARREN AVE.",
"city": "SELMER",
"state": "TN",
"postal_code": "38375",
"telephone_number": "731-645-3850",
"fax_number": "731-645-3851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PITTS",
"first_name": "BOBBY",
"middle_name": "SHAWN",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "TN",
"license": "761",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3675861",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Selmer, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.