Provider Demographics
NPI:1326150848
Name:SPINK, TIMOTHY LESTON (DC DR OF CHIROPRACTI)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:LESTON
Last Name:SPINK
Suffix:
Gender:M
Credentials:DC DR OF CHIROPRACTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-0460
Mailing Address - Country:US
Mailing Address - Phone:989-695-6260
Mailing Address - Fax:989-695-4674
Practice Address - Street 1:135 E WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-0460
Practice Address - Country:US
Practice Address - Phone:989-265-6260
Practice Address - Fax:989-695-4674
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITS004929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOG35024Medicare ID - Type Unspecified
OG35024Medicare UPIN