Provider Demographics
NPI:1376611798
Name:GUTHMAN, TIMOTHY WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WAYNE
Last Name:GUTHMAN
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 1:2125 UPPER 55TH ST E
Mailing Address - Street 2:SUITE 250
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55077-1734
Mailing Address - Country:US
Mailing Address - Phone:651-451-3311
Mailing Address - Fax:
Practice Address - Street 1:2125 UPPER 55TH ST E
Practice Address - Street 2:SUITE 250
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-1734
Practice Address - Country:US
Practice Address - Phone:651-451-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU76190Medicare UPIN