Provider Demographics
NPI:1699859819
Name:DEFLORIAN, TIMOTHY J (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:DEFLORIAN
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 1:214 MAPLE ST S STE A
Mailing Address - Street 2:P.O. BOX 65
Mailing Address - City:TURTLE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54889-8003
Mailing Address - Country:US
Mailing Address - Phone:715-986-2220
Mailing Address - Fax:
Practice Address - Street 1:214 MAPLE ST S STE A
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54889-8003
Practice Address - Country:US
Practice Address - Phone:715-986-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38867500Medicaid
WI70426Medicare ID - Type Unspecified
WI38867500Medicaid