Provider Demographics
NPI:1407894405
Name:TAIG, TIMOTHY ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:TAIG
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 1:5510 CASCADE RD SE
Mailing Address - Street 2:STE 280
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6496
Mailing Address - Country:US
Mailing Address - Phone:616-949-9282
Mailing Address - Fax:616-949-2374
Practice Address - Street 1:5510 CASCADE RD SE
Practice Address - Street 2:STE 280
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6496
Practice Address - Country:US
Practice Address - Phone:616-949-9282
Practice Address - Fax:616-949-2374
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11N00000XOtherTAXONOMY
MI2301008724OtherMI CHIROPRACTIC LICENSE
MI11567401OtherCAQH
MI11N00000XOtherTAXONOMY
MI11567401OtherCAQH