Provider Demographics
NPI:1689685893
Name:GUEST, TIMOTHY D (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:D
Last Name:GUEST
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 1:1269 BARCLAY CIR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2903
Mailing Address - Country:US
Mailing Address - Phone:770-426-2935
Mailing Address - Fax:770-426-2719
Practice Address - Street 1:2020 SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-7251
Practice Address - Country:US
Practice Address - Phone:864-578-8770
Practice Address - Fax:864-599-4858
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008172111N00000X
SC1192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1192Medicaid
SCT244950282Medicare PIN
SCT24495Medicare UPIN