Provider Demographics
NPI:1497869754
Name:DEMCHAK, TIMOTHY J (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:DEMCHAK
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W LAWRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2070
Mailing Address - Country:US
Mailing Address - Phone:812-877-3633
Mailing Address - Fax:
Practice Address - Street 1:2 W LAWRIN BLVD
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2070
Practice Address - Country:US
Practice Address - Phone:812-877-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001072A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist