Provider Demographics
NPI:1669687273
Name:LEVIN, TIMOTHY ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:LEVIN
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 1:7700 JEWELLA AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-5050
Mailing Address - Country:US
Mailing Address - Phone:318-688-8361
Mailing Address - Fax:
Practice Address - Street 1:7700 JEWELLA AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-5050
Practice Address - Country:US
Practice Address - Phone:318-688-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B556Medicare ID - Type UnspecifiedMEDICARE NUMBER