Provider Demographics
NPI:1518422153
Name:TIM GUDILIN CHIROPRACTIC INC
Entity Type:Organization
Organization Name:TIM GUDILIN CHIROPRACTIC INC
Other - Org Name:CHIROPRACTIC FIRST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUDILIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-559-1662
Mailing Address - Street 1:CHIROPRACTIC FIRST
Mailing Address - Street 2:3195 S BASCOM AVE
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-6728
Mailing Address - Country:US
Mailing Address - Phone:408-559-1662
Mailing Address - Fax:408-559-0946
Practice Address - Street 1:CHIROPRACTIC FIRST
Practice Address - Street 2:3195 S BASCOM AVE
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6728
Practice Address - Country:US
Practice Address - Phone:408-559-1662
Practice Address - Fax:408-559-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty