Provider Demographics
NPI:1366658031
Name:STEVEN M. TIMMER D.C., P.C.
Entity Type:Organization
Organization Name:STEVEN M. TIMMER D.C., P.C.
Other - Org Name:CHIROPRACTIC CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-781-6556
Mailing Address - Street 1:935 W LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2104
Mailing Address - Country:US
Mailing Address - Phone:816-781-6556
Mailing Address - Fax:816-781-6847
Practice Address - Street 1:935 W LIBERTY DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2104
Practice Address - Country:US
Practice Address - Phone:816-781-6556
Practice Address - Fax:816-781-6847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO30296021OtherBLUE CROSS BLUE SHIELD
MOU87263Medicare UPIN
MOL37B386Medicare ID - Type UnspecifiedINDIVIDUAL
MO30296021OtherBLUE CROSS BLUE SHIELD