Provider Demographics
NPI:1285634147
Name:PURCELL, TIMOTHY RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RYAN
Last Name:PURCELL
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 1:111 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-2237
Mailing Address - Country:US
Mailing Address - Phone:814-734-3991
Mailing Address - Fax:814-734-0812
Practice Address - Street 1:111 WALKER DR
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-2237
Practice Address - Country:US
Practice Address - Phone:814-734-3991
Practice Address - Fax:814-734-0812
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019386290002Medicaid
PA1445674OtherHIGHMARK
PA1445674OtherHIGHMARK
PA066891Medicare ID - Type UnspecifiedMEDICARE