Provider Demographics
NPI:1497102081
Name:LOSBY, TIMOTHY JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAY
Last Name:LOSBY
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 1:1221 BOWER PKWY
Mailing Address - Street 2:#108
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-3732
Mailing Address - Country:US
Mailing Address - Phone:803-708-4258
Mailing Address - Fax:803-708-4373
Practice Address - Street 1:1221 BOWER PKWY
Practice Address - Street 2:#108
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3732
Practice Address - Country:US
Practice Address - Phone:803-708-4258
Practice Address - Fax:803-708-4373
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor