Provider Demographics
NPI:1588678353
Name:MURRAY, TIMOTHY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:MURRAY
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 1:31540 SCHOOLCRAFT
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-2611
Mailing Address - Country:US
Mailing Address - Phone:586-322-3730
Mailing Address - Fax:586-296-5647
Practice Address - Street 1:31388 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2450
Practice Address - Country:US
Practice Address - Phone:586-296-6242
Practice Address - Fax:586-296-5647
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E05088OtherBLUE CROSS
382903197OtherFED TAX ID
7155154OtherAETNA
MI264081214Medicaid
7155154OtherAETNA
MI950E05088OtherBLUE CROSS