Provider Demographics
NPI:1629052402
Name:FLORA, TIMOTHY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LEE
Last Name:FLORA
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 1:315 NE KIRBY ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4301
Mailing Address - Country:US
Mailing Address - Phone:503-472-2111
Mailing Address - Fax:503-434-5886
Practice Address - Street 1:315 NE KIRBY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4301
Practice Address - Country:US
Practice Address - Phone:503-472-2111
Practice Address - Fax:503-434-5886
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR271639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000QGCFQMedicare ID - Type Unspecified