Provider Demographics
NPI:1194865626
Name:WASMUND, TIMOTHY M (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:WASMUND
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 1:1420 N ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1188
Mailing Address - Country:US
Mailing Address - Phone:248-650-6100
Mailing Address - Fax:248-650-3751
Practice Address - Street 1:1420 N ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-650-6100
Practice Address - Fax:248-650-3751
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITW009294111N00000X
MI2301009294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI10006001Medicare PIN