Provider Demographics
NPI:1043391097
Name:OWENS, TIMOTHY STONE (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:STONE
Last Name:OWENS
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 1:12 W AVON RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3583
Mailing Address - Country:US
Mailing Address - Phone:860-673-5665
Mailing Address - Fax:860-673-2084
Practice Address - Street 1:12 W AVON RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3583
Practice Address - Country:US
Practice Address - Phone:860-673-5665
Practice Address - Fax:860-673-2084
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT23238Medicare UPIN