Provider Demographics
NPI:1609868215
Name:MESICK, TIMOTHY WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:MESICK
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:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-0020
Mailing Address - Country:US
Mailing Address - Phone:563-344-0707
Mailing Address - Fax:563-344-6769
Practice Address - Street 1:5302 ELMORE AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3859
Practice Address - Country:US
Practice Address - Phone:563-344-0707
Practice Address - Fax:563-377-6769
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0212290Medicaid
IA48695OtherBLUE CROSS / BLUE SHIELD
I1291Medicare ID - Type Unspecified
IA48695OtherBLUE CROSS / BLUE SHIELD