Provider Demographics
NPI:1235225947
Name:SEXTON, TIMOTHY RUSSELL (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RUSSELL
Last Name:SEXTON
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 1:5921 SE 14TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-1746
Mailing Address - Country:US
Mailing Address - Phone:515-287-3993
Mailing Address - Fax:515-287-3044
Practice Address - Street 1:5921 SE 14TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1746
Practice Address - Country:US
Practice Address - Phone:515-287-3993
Practice Address - Fax:515-287-3044
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24151OtherBCBS
IAI11734Medicare ID - Type Unspecified
IA24151OtherBCBS