Provider Demographics
NPI:1891816849
Name:BIRDSALL, TIMOTHY CARROLL (ND)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CARROLL
Last Name:BIRDSALL
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W NORTHERN LIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2408
Mailing Address - Country:US
Mailing Address - Phone:907-770-6700
Mailing Address - Fax:
Practice Address - Street 1:915 W NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2408
Practice Address - Country:US
Practice Address - Phone:907-770-6700
Practice Address - Fax:907-770-6707
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09-1093175F00000X
WANT00000477175F00000X
CAND902175F00000X
AK199283175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath