Provider Demographics
NPI:1518017078
Name:GOULART, TIMOTHY (DC, CVCP)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:GOULART
Suffix:
Gender:M
Credentials:DC, CVCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TIMOTHY GOULART 24 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015
Mailing Address - Country:US
Mailing Address - Phone:541-788-4958
Mailing Address - Fax:785-456-2048
Practice Address - Street 1:VETERANS ADMINISTRATION MEDICAL CENTER
Practice Address - Street 2:5500 ARMSTRONG RD
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037
Practice Address - Country:US
Practice Address - Phone:269-966-5680
Practice Address - Fax:541-388-0839
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-2184111N00000X
MO201802941111N00000X
OK4402111N00000X
OR272267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR116939Medicare PIN