Provider Demographics
NPI:1477644565
Name:DUNNE, TIMOTHY ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ANTHONY
Last Name:DUNNE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:ANTHONY
Other - Last Name:DUNNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:215 E WATAUGA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4629
Mailing Address - Country:US
Mailing Address - Phone:423-388-3643
Mailing Address - Fax:423-388-3561
Practice Address - Street 1:215 E WATAUGA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4629
Practice Address - Country:US
Practice Address - Phone:423-388-3643
Practice Address - Fax:423-388-3561
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2238111N00000X
MI2301007102111N00000X
TN2552111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000316403OtherANTHEM
MI950E810930OtherBCBSM
TN4311318OtherBCBST
OH2186558Medicaid
TN4311318OtherBCBST
MIOP25980Medicare UPIN
MIP25980001Medicare ID - Type Unspecified
TN4311318OtherBCBST