Provider Demographics
NPI:1831162866
Name:TITUS CHIROPRACTIC PC
Entity type:Organization
Organization Name:TITUS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-465-6407
Mailing Address - Street 1:370 E 300 N
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:219-465-6407
Mailing Address - Fax:219-531-9035
Practice Address - Street 1:370 E 300 N
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-465-6407
Practice Address - Fax:219-531-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000292111OtherBLUE SHIELD
U70574Medicare UPIN
IN000000292111OtherBLUE SHIELD