Provider Demographics
NPI:1457452542
Name:KANADY, TIMOTHY K (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:K
Last Name:KANADY
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 1:1113 W FIREWEED LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-1771
Mailing Address - Country:US
Mailing Address - Phone:907-272-2700
Mailing Address - Fax:907-272-2702
Practice Address - Street 1:1113 W FIREWEED LN
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-1771
Practice Address - Country:US
Practice Address - Phone:907-272-2700
Practice Address - Fax:907-272-2702
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK176111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0044Medicaid
AKCH0044Medicaid
AK0000QGHHFMedicare ID - Type Unspecified