Provider Demographics
NPI:1477899805
Name:WEECH, TIMOTHY GORDON (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GORDON
Last Name:WEECH
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 1:1002 S TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:IL
Mailing Address - Zip Code:61530-1693
Mailing Address - Country:US
Mailing Address - Phone:309-648-9512
Mailing Address - Fax:
Practice Address - Street 1:140 W 6TH ST
Practice Address - Street 2:
Practice Address - City:MINONK
Practice Address - State:IL
Practice Address - Zip Code:61760
Practice Address - Country:US
Practice Address - Phone:309-432-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7884Medicare PIN