Provider Demographics
NPI:1114278199
Name:TOLITSKY, MELINDA (DC)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:
Last Name:TOLITSKY
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 1:309 KINGSLEY LAKE DR
Mailing Address - Street 2:SUITE 904
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3047
Mailing Address - Country:US
Mailing Address - Phone:904-547-2435
Mailing Address - Fax:904-547-2419
Practice Address - Street 1:309 KINGSLEY LAKE DR
Practice Address - Street 2:SUITE 904
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3047
Practice Address - Country:US
Practice Address - Phone:904-547-2435
Practice Address - Fax:904-547-2419
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor