Provider Demographics
NPI:1336128974
Name:DUNAGAN, TIMOTHY L (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:L
Last Name:DUNAGAN
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 1:620 N CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4375
Mailing Address - Country:US
Mailing Address - Phone:308-381-1312
Mailing Address - Fax:308-381-6365
Practice Address - Street 1:620 N CUSTER AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4375
Practice Address - Country:US
Practice Address - Phone:308-381-1312
Practice Address - Fax:308-381-6365
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470638861-00Medicaid
NE009513OtherBLUE CROSS BLUE SHIELD
NE091471Medicare PIN
NE470638861-00Medicaid
NE009513OtherBLUE CROSS BLUE SHIELD