Provider Demographics
NPI:1649239161
Name:HAMP, TIMOTHY J (DC FASA)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:HAMP
Suffix:
Gender:M
Credentials:DC FASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4410
Mailing Address - Country:US
Mailing Address - Phone:507-235-6629
Mailing Address - Fax:507-235-6620
Practice Address - Street 1:1125 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4410
Practice Address - Country:US
Practice Address - Phone:507-235-6629
Practice Address - Fax:507-235-6620
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2034111N00000X
MN223171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN42215HAOtherBCBS
MN359000356Medicare PIN