Provider Demographics
NPI:1649384645
Name:LANIER, TIMOTHY (DC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:LANIER
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 1:1141 RIDGE RD # A
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4217
Mailing Address - Country:US
Mailing Address - Phone:972-771-9844
Mailing Address - Fax:972-771-4674
Practice Address - Street 1:1141 RIDGE RD # A
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4217
Practice Address - Country:US
Practice Address - Phone:972-771-9844
Practice Address - Fax:972-771-4674
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00784HMedicare PIN