Provider Demographics
NPI:1073692059
Name:SHAH, TIMOTHY R (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:R
Last Name:SHAH
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 1:23280 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3100
Mailing Address - Country:US
Mailing Address - Phone:248-477-1492
Mailing Address - Fax:
Practice Address - Street 1:23280 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3100
Practice Address - Country:US
Practice Address - Phone:248-477-1492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MITS007122OtherBLUE CROSS-MY LICENSE #
MI950F353850OtherBLUE CROSS
MI350043437OtherMEDICARE RAILROAD
MIOM50840Medicare ID - Type Unspecified
MIU67577Medicare UPIN