MEDICARE: LON S TITEN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B01059	NV
2	111N00000X	Chiropractor	16902	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B01059	OTHER	NV	NEVADA LICENSE NUMBER
2	16902	OTHER	CA	CALIFORNIA LICENSE NUMBER

General Provider Information

NPI Number	:	1396755716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LON S TITEN D.C.

Provider Business Mailing Address
First Line	:	2956 FOXTAIL CREEK AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-7077
Country	:	US
Telephone Number	:	702-598-0500
Fax Number	:	702-433-0029

Provider Business Practice Location Address
First Line	:	4660 S EASTERN AVE
Second Line	:	SUITE 202
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6137
Country	:	US
Telephone Number	:	702-598-0500
Fax Number	:	702-433-0029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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Directions to “ LON S TITEN D.C.” Practice Location

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