Provider Demographics
NPI:1962581041
Name:TITAN SPINE AND SPORTS MEDICINE INC
Entity type:Organization
Organization Name:TITAN SPINE AND SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:EMIL
Authorized Official - Last Name:DACANAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-908-8776
Mailing Address - Street 1:4961 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4813
Mailing Address - Country:US
Mailing Address - Phone:813-908-8776
Mailing Address - Fax:813-908-8704
Practice Address - Street 1:4961 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4813
Practice Address - Country:US
Practice Address - Phone:813-908-8776
Practice Address - Fax:813-908-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8788111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV01925Medicare UPIN
FLAE139Medicare PIN