Provider Demographics
NPI:1629063482
Name:MCKINLEY, TIMOTHY JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAY
Last Name:MCKINLEY
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 1:2000 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-4110
Mailing Address - Country:US
Mailing Address - Phone:713-921-1784
Mailing Address - Fax:713-921-9124
Practice Address - Street 1:2000 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-4110
Practice Address - Country:US
Practice Address - Phone:713-921-1784
Practice Address - Fax:713-921-9124
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2007-07-09
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TX4979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1651127Medicaid
TX602049Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER