Provider Demographics
NPI:1912000456
Name:HOYT, TIMOTHY MARK (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MARK
Last Name:HOYT
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 1:201 N. FLORENCE STREET
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222
Mailing Address - Country:US
Mailing Address - Phone:520-836-6700
Mailing Address - Fax:520-836-4686
Practice Address - Street 1:201 N FLORENCE ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4420
Practice Address - Country:US
Practice Address - Phone:520-836-6700
Practice Address - Fax:520-836-4686
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1912000456OtherNPI
AZ1Z8535OtherHEALTHNET ID
AZ860574384OtherTAX ID
AZAZ0231280OtherBC ID
AZZ$$$$$$$$$Medicare UPIN