Provider Demographics
NPI:1285817072
Name:TIMKO, PETER S (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:TIMKO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:P.
Other - Middle Name:SCOTT
Other - Last Name:TIMKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2735 W UNION HILLS DR
Mailing Address - Street 2:STE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5033
Mailing Address - Country:US
Mailing Address - Phone:602-973-1630
Mailing Address - Fax:602-973-1667
Practice Address - Street 1:2735 W UNION HILLS DR
Practice Address - Street 2:STE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5033
Practice Address - Country:US
Practice Address - Phone:602-973-1630
Practice Address - Fax:602-973-1667
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ05748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ72964OtherMC ORGANIZATIONAL PROV ID
AZZ72965OtherMC PROVIDER INDIVIDUAL ID
AZU76513Medicare UPIN