Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CHIRO007991 | GA |
N | 111NS0005X | Chiropractic Sports Physician | DC006779L | PA |
NPI | 1326147075 |
---|---|
Provider Name | Dr. Todd Michael Titus |
First Address | Savannah, GA 31405-1081 |
Second Address | Savannah, GA 31406-3425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 30/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000768617 | (02) | PA |
0189894000 | (02) | PA |
0651504000 | (02) | PA |
2718884 | AETNA PIN (01) | PA |