Provider Demographics
NPI:1487667820
Name:DOLAN, TIMOTHY WALTER (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WALTER
Last Name:DOLAN
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 1:2441 E HWY 377
Mailing Address - Street 2:101
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-5991
Mailing Address - Country:US
Mailing Address - Phone:817-579-9444
Mailing Address - Fax:817-579-9457
Practice Address - Street 1:2441 E HWY 377
Practice Address - Street 2:101
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-5991
Practice Address - Country:US
Practice Address - Phone:817-579-9444
Practice Address - Fax:817-579-9457
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4333111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2817Medicare PIN