Provider Demographics
NPI:1033219118
Name:COCHRAN, TIMOTHY DUANE (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DUANE
Last Name:COCHRAN
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 1:6307 HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-5020
Mailing Address - Country:US
Mailing Address - Phone:515-277-3716
Mailing Address - Fax:515-277-7181
Practice Address - Street 1:6307 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-5020
Practice Address - Country:US
Practice Address - Phone:515-277-3716
Practice Address - Fax:515-277-7181
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0168757Medicaid
T0994Medicare UPIN
IA0168757Medicaid