Provider Demographics
NPI:1235161456
Name:SEXTON, TIMOTHY L (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:L
Last Name:SEXTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:L
Other - Last Name:SEXTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:4213 COUNTY ROAD 218
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-4880
Mailing Address - Country:US
Mailing Address - Phone:904-282-3917
Mailing Address - Fax:
Practice Address - Street 1:4213 COUNTY ROAD 218
Practice Address - Street 2:SUITE 5
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-4880
Practice Address - Country:US
Practice Address - Phone:904-282-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4491111N00000X
FLCH9303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU73880Medicare UPIN