Provider Demographics
NPI:1407863640
Name:BESSETTE, TIMOTHY PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:BESSETTE
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 1:401 E NORTH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-1218
Mailing Address - Country:US
Mailing Address - Phone:630-782-6637
Mailing Address - Fax:630-782-0726
Practice Address - Street 1:401 E NORTH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-1218
Practice Address - Country:US
Practice Address - Phone:630-782-6637
Practice Address - Fax:630-782-0726
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL320640Medicare ID - Type Unspecified