Provider Demographics
NPI:1235207507
Name:VIERHELLER, TIMOTHY LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LOUIS
Last Name:VIERHELLER
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 1:1348 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1828
Mailing Address - Country:US
Mailing Address - Phone:419-529-6024
Mailing Address - Fax:419-529-6047
Practice Address - Street 1:1348 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1828
Practice Address - Country:US
Practice Address - Phone:419-529-6024
Practice Address - Fax:419-529-6047
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000290929OtherANTHEM
OH2304152Medicaid
OHRI9328891Medicare ID - Type Unspecified
OH000000290929OtherANTHEM