Provider Demographics
NPI:1356627459
Name:TIMOTHY R VAN CLEVE LTD APCC
Entity Type:Organization
Organization Name:TIMOTHY R VAN CLEVE LTD APCC
Other - Org Name:MAPLEWOOD CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-625-4077
Mailing Address - Street 1:214 S CITIES SERVICE HWY
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-6404
Mailing Address - Country:US
Mailing Address - Phone:337-625-4077
Mailing Address - Fax:337-625-5938
Practice Address - Street 1:214 S CITIES SERVICE HWY
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-6404
Practice Address - Country:US
Practice Address - Phone:337-625-4077
Practice Address - Fax:337-625-5938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11-00000106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty