Provider Demographics
NPI:1063503969
Name:BARRY, TIMOTHY KEITH (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:KEITH
Last Name:BARRY
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:PO BOX 1505
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-0505
Mailing Address - Country:US
Mailing Address - Phone:310-365-7162
Mailing Address - Fax:
Practice Address - Street 1:7240 NOLENSVILLE RD STE 302
Practice Address - Street 2:
Practice Address - City:NOLENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37135-9502
Practice Address - Country:US
Practice Address - Phone:615-283-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27203111N00000X
TN2997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor