Provider Demographics
NPI:1609836147
Name:TITUS, CASEY (DC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:TITUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:ELLEN
Other - Last Name:TITUS DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 OCEAN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3616
Mailing Address - Country:US
Mailing Address - Phone:252-261-3100
Mailing Address - Fax:252-261-3240
Practice Address - Street 1:1 OCEAN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3616
Practice Address - Country:US
Practice Address - Phone:252-261-3100
Practice Address - Fax:252-261-3240
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556368111N00000X
NC3669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11469679OtherCAQH
VA11469679OtherCAQH
VA00W499C94Medicare ID - Type Unspecified