Provider Demographics
NPI:1760481964
Name:KLESMIT, TIMOTHY RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RICHARD
Last Name:KLESMIT
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 1:1014 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2320
Mailing Address - Country:US
Mailing Address - Phone:972-296-1566
Mailing Address - Fax:972-296-3060
Practice Address - Street 1:1014 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2320
Practice Address - Country:US
Practice Address - Phone:972-296-1566
Practice Address - Fax:972-296-3060
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8156K0Medicare PIN
TXX47901Medicare UPIN