Provider Demographics
NPI:1174663520
Name:TIMONER, JULIAN B (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:B
Last Name:TIMONER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3416
Mailing Address - Country:US
Mailing Address - Phone:203-483-7778
Mailing Address - Fax:203-481-0234
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3416
Practice Address - Country:US
Practice Address - Phone:203-483-7778
Practice Address - Fax:203-481-0234
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22576Medicare UPIN