Provider Demographics
NPI:1760448732
Name:DAWSON, TIMOTHY P (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:P
Last Name:DAWSON
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 1:12250 TAMIAMI TRL E
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-8108
Mailing Address - Country:US
Mailing Address - Phone:239-774-4041
Mailing Address - Fax:
Practice Address - Street 1:12250 TAMIAMI TRL E
Practice Address - Street 2:SUITE 206
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8108
Practice Address - Country:US
Practice Address - Phone:239-774-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75907Medicare UPIN
FLE6295AMedicare ID - Type Unspecified