Provider Demographics
NPI:1689840746
Name:TIMBERLAKE CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:TIMBERLAKE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-446-2242
Mailing Address - Street 1:1511 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5452
Mailing Address - Country:US
Mailing Address - Phone:573-446-2242
Mailing Address - Fax:573-446-5575
Practice Address - Street 1:1511 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5452
Practice Address - Country:US
Practice Address - Phone:573-446-2242
Practice Address - Fax:573-446-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT89005Medicare UPIN
MO000031359Medicare PIN