Provider Demographics
NPI:1689660326
Name:TIMOTHY D. STUDT, D.C., P.C.
Entity Type:Organization
Organization Name:TIMOTHY D. STUDT, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:STUDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-681-2533
Mailing Address - Street 1:1883 W MONROE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MI
Mailing Address - Zip Code:48880-9789
Mailing Address - Country:US
Mailing Address - Phone:989-681-2533
Mailing Address - Fax:989-681-2533
Practice Address - Street 1:1883 W MONROE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880-9789
Practice Address - Country:US
Practice Address - Phone:989-681-2533
Practice Address - Fax:989-681-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITS005329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI144269362Medicaid
MI950B910390OtherBLUE CROSS BLUE SHIELD
MI950B910390OtherBLUE CROSS BLUE SHIELD
MI0P18060Medicare ID - Type Unspecified