Provider Demographics
NPI:1578692836
Name:PEARSON, TIM ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:ALLEN
Last Name:PEARSON
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 1:3541 129TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2101
Mailing Address - Country:US
Mailing Address - Phone:515-331-2208
Mailing Address - Fax:
Practice Address - Street 1:132 W MAIN ST
Practice Address - Street 2:BOX 546
Practice Address - City:PANORA
Practice Address - State:IA
Practice Address - Zip Code:50216-1018
Practice Address - Country:US
Practice Address - Phone:641-755-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA52658Medicare ID - Type Unspecified