Provider Demographics
NPI:1871647172
Name:CARTWRIGHT, TIMOTHY A
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:CARTWRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14989 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3769
Mailing Address - Country:US
Mailing Address - Phone:734-243-2210
Mailing Address - Fax:723-243-1663
Practice Address - Street 1:14989 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3769
Practice Address - Country:US
Practice Address - Phone:734-243-2210
Practice Address - Fax:723-243-1663
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2685111N00000X
MI382340241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT98758Medicare UPIN
MI0E850270951Medicare ID - Type Unspecified