Provider Demographics
NPI:1326077553
Name:ST ONGE, TIMOTHY JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:ST ONGE
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 1:574 HIGHWAY 248 STE 4
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7733
Mailing Address - Country:US
Mailing Address - Phone:417-598-0080
Mailing Address - Fax:888-463-8877
Practice Address - Street 1:574 HIGHWAY 248 STE 4
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7733
Practice Address - Country:US
Practice Address - Phone:417-598-0080
Practice Address - Fax:888-463-8877
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB164587OtherMEDICARE PTAN
TXTXB164587OtherMEDICARE PTAN