Provider Demographics
NPI:1609957836
Name:KANE, TIMOTHY J (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:KANE
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 1:357 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9613
Mailing Address - Country:US
Mailing Address - Phone:563-599-0785
Mailing Address - Fax:
Practice Address - Street 1:122 N MAIN ST.
Practice Address - Street 2:
Practice Address - City:ELKADER
Practice Address - State:IA
Practice Address - Zip Code:52043-0839
Practice Address - Country:US
Practice Address - Phone:563-245-2928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-0507856OtherTAX ID
IA36160OtherBC/BS
IA0423780Medicaid