Provider Demographics
NPI:1851425490
Name:TMD LLC
Entity Type:Organization
Organization Name:TMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BEHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-256-1093
Mailing Address - Street 1:3662 W INA RD
Mailing Address - Street 2:STE. 180
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2269
Mailing Address - Country:US
Mailing Address - Phone:520-256-1093
Mailing Address - Fax:
Practice Address - Street 1:3662 W INA RD
Practice Address - Street 2:STE. 180
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2269
Practice Address - Country:US
Practice Address - Phone:520-256-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ104703Medicare ID - Type Unspecified