Provider Demographics
NPI:1407016942
Name:ML TIMM A CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:ML TIMM A CHIROPRACTIC CORP
Other - Org Name:HETRICK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:LINDSAY
Authorized Official - Last Name:TIMM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-741-0774
Mailing Address - Street 1:560 S ESCONDIDO BLVD
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4816
Mailing Address - Country:US
Mailing Address - Phone:760-741-0774
Mailing Address - Fax:760-741-0775
Practice Address - Street 1:560 S ESCONDIDO BLVD
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4816
Practice Address - Country:US
Practice Address - Phone:760-741-0774
Practice Address - Fax:760-741-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29376261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service