Provider Demographics
NPI:1619570090
Name:OUELLETTE, TIMOTHY MARCEL (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MARCEL
Last Name:OUELLETTE
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 1:43 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2308
Mailing Address - Country:US
Mailing Address - Phone:860-793-6824
Mailing Address - Fax:
Practice Address - Street 1:43 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2308
Practice Address - Country:US
Practice Address - Phone:860-793-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor