Provider Demographics
NPI:1619966173
Name:TRAX, TIMOTHY E (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:E
Last Name:TRAX
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 1:2955 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4227
Mailing Address - Country:US
Mailing Address - Phone:419-474-9019
Mailing Address - Fax:419-474-9060
Practice Address - Street 1:2955 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4227
Practice Address - Country:US
Practice Address - Phone:419-474-9019
Practice Address - Fax:419-473-8680
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTR0645752Medicare ID - Type Unspecified
OHU19355Medicare UPIN