Healthcare Provider Details

I. General information

NPI: 1114278199
Provider Name (Legal Business Name): MELINDA TOLITSKY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 KINGSLEY LAKE DR SUITE 904
SAINT AUGUSTINE FL
32092-3047
US

IV. Provider business mailing address

309 KINGSLEY LAKE DR SUITE 904
SAINT AUGUSTINE FL
32092-3047
US

V. Phone/Fax

Practice location:
  • Phone: 904-547-2435
  • Fax: 904-547-2419
Mailing address:
  • Phone: 904-547-2435
  • Fax: 904-547-2419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 10335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: