Provider Demographics
NPI:1477026193
Name:GODEK, TIMOTHY (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:GODEK
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 1:1640 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1707
Mailing Address - Country:US
Mailing Address - Phone:440-639-9171
Mailing Address - Fax:440-579-0119
Practice Address - Street 1:1640 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1707
Practice Address - Country:US
Practice Address - Phone:440-639-9171
Practice Address - Fax:440-579-0119
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor