Provider Demographics
NPI:1558566299
Name:BORTZ, TIMOTHY J (DC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:BORTZ
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 1:3260 MURRELL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4407
Mailing Address - Country:US
Mailing Address - Phone:321-631-1100
Mailing Address - Fax:321-637-1030
Practice Address - Street 1:3260 MURRELL RD STE 101
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4407
Practice Address - Country:US
Practice Address - Phone:321-631-1100
Practice Address - Fax:321-637-1030
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor