Provider Demographics
NPI:1396755716
Name:TITEN, LON S (DC)
Entity type:Individual
Prefix:
First Name:LON
Middle Name:S
Last Name:TITEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2956 FOXTAIL CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-7077
Mailing Address - Country:US
Mailing Address - Phone:702-598-0500
Mailing Address - Fax:702-433-0029
Practice Address - Street 1:4660 S EASTERN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6137
Practice Address - Country:US
Practice Address - Phone:702-598-0500
Practice Address - Fax:702-433-0029
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01059111N00000X
CA16902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVB01059OtherNEVADA LICENSE NUMBER
CA16902OtherCALIFORNIA LICENSE NUMBER