Provider Demographics
NPI:1518013853
Name:TIMAR, ROBERT DEAN (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DEAN
Last Name:TIMAR
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:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-0686
Mailing Address - Country:US
Mailing Address - Phone:952-229-7464
Mailing Address - Fax:
Practice Address - Street 1:9000 SIX PINES DR
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-4271
Practice Address - Country:US
Practice Address - Phone:346-786-5988
Practice Address - Fax:952-474-1504
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC261570111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0261570Medicare ID - Type Unspecified