Provider Demographics
NPI:1710018825
Name:TIMOTHY W. DOLAN DC PA
Entity Type:Organization
Organization Name:TIMOTHY W. DOLAN DC PA
Other - Org Name:DOLAN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-579-9444
Mailing Address - Street 1:2441 E HIGHWAY 377
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-5991
Mailing Address - Country:US
Mailing Address - Phone:817-579-9444
Mailing Address - Fax:817-579-9457
Practice Address - Street 1:2441 E HIGHWAY 377
Practice Address - Street 2:SUITE 101
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-5991
Practice Address - Country:US
Practice Address - Phone:817-579-9444
Practice Address - Fax:817-579-9457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4333111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W432Medicare PIN