Provider Demographics
NPI:1073819678
Name:PICKENS, TIMOTHY HIDEYO (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:HIDEYO
Last Name:PICKENS
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 1:1225 S MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5384
Mailing Address - Country:US
Mailing Address - Phone:724-836-7246
Mailing Address - Fax:724-219-3034
Practice Address - Street 1:1225 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5384
Practice Address - Country:US
Practice Address - Phone:724-836-7246
Practice Address - Fax:724-219-3034
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0102119111N00000X
PADC010343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor