Provider Demographics
NPI:1083969729
Name:TITO, COLLEEN ALMA (DC)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:ALMA
Last Name:TITO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 MIDDLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-2013
Mailing Address - Country:US
Mailing Address - Phone:203-228-3644
Mailing Address - Fax:
Practice Address - Street 1:180 PINNACLES DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2596
Practice Address - Country:US
Practice Address - Phone:904-300-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001922111N00000X
FL12388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor