Provider Demographics
NPI:1508337015
Name:GAGAN, TIMOTHY ALOYSIUS (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALOYSIUS
Last Name:GAGAN
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 1:1661 KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9311
Mailing Address - Country:US
Mailing Address - Phone:315-604-6572
Mailing Address - Fax:
Practice Address - Street 1:1661 KENNEDY RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9311
Practice Address - Country:US
Practice Address - Phone:315-604-6572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0131901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor