Provider Demographics
NPI:1598886384
Name:STRANAHAN, TIMOTHY M (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:STRANAHAN
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 1:4214 MEDICAL PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3323
Mailing Address - Country:US
Mailing Address - Phone:512-458-9200
Mailing Address - Fax:512-458-9300
Practice Address - Street 1:4214 MEDICAL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3323
Practice Address - Country:US
Practice Address - Phone:512-458-9200
Practice Address - Fax:512-458-9300
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5485OtherLICENSE
TX605854OtherBCBS
TX261315985OtherTIN
TX605854OtherBCBS