Provider Demographics
NPI:1033278403
Name:JAY, TIMOTHY GUY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GUY
Last Name:JAY
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 1:6924 PROFESSIONAL PKWY E
Mailing Address - Street 2:STE B
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8420
Mailing Address - Country:US
Mailing Address - Phone:941-362-4000
Mailing Address - Fax:941-362-4400
Practice Address - Street 1:6924 PROFESSIONAL PKWY E STE B
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8439
Practice Address - Country:US
Practice Address - Phone:941-362-4000
Practice Address - Fax:941-362-4400
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88638OtherBCBS
FL88638OtherBCBS
FL88638ZMedicare PIN