Provider Demographics
NPI:1487869590
Name:JOHN TITCOMB, D.C,P.C.
Entity type:Organization
Organization Name:JOHN TITCOMB, D.C,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TITCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-549-0749
Mailing Address - Street 1:1206 E JERICHO TPKE UNIT A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-5453
Mailing Address - Country:US
Mailing Address - Phone:631-549-0749
Mailing Address - Fax:631-549-1562
Practice Address - Street 1:1206 E JERICHO TPKE UNIT A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-5453
Practice Address - Country:US
Practice Address - Phone:631-549-0749
Practice Address - Fax:631-549-1562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX005717Medicare ID - Type UnspecifiedCHIROPRACTOR
NYT81281Medicare UPIN