Provider Demographics
NPI:1598743163
Name:SMITH, TIMOTHY ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:SMITH
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 1:7174 ERIE RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9701
Mailing Address - Country:US
Mailing Address - Phone:716-947-5106
Mailing Address - Fax:716-947-9329
Practice Address - Street 1:7174 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9701
Practice Address - Country:US
Practice Address - Phone:716-947-5106
Practice Address - Fax:716-947-9329
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010563-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8891577OtherINDEPENDENT HEALTH
NYC10563-7BOtherNYS WCB
NYC10563-7BOtherNYS WCB