Provider Demographics
NPI:1053400671
Name:MYERS, TIMOTHY FREDERICK (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:FREDERICK
Last Name:MYERS
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 1:7942 N MAPLE
Mailing Address - Street 2:#109
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-298-0124
Mailing Address - Fax:
Practice Address - Street 1:7942 N MAPLE
Practice Address - Street 2:#109
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-298-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC014165Medicare UPIN
CADC014165Medicare ID - Type Unspecified