Provider Demographics
NPI:1134403108
Name:TITUSVILLE CHIROPRACTIC & INJURY CENTER, INC.
Entity type:Organization
Organization Name:TITUSVILLE CHIROPRACTIC & INJURY CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:H
Authorized Official - Last Name:TRASTELIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-847-7108
Mailing Address - Street 1:850 CENTURY MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796
Mailing Address - Country:US
Mailing Address - Phone:321-226-1115
Mailing Address - Fax:321-251-6091
Practice Address - Street 1:850 CENTURY MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796
Practice Address - Country:US
Practice Address - Phone:321-226-1115
Practice Address - Fax:321-251-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9957111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty