Provider Demographics
NPI:1932673647
Name:GUDILIN, TIMOTHY J (DC-CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:GUDILIN
Suffix:
Gender:M
Credentials:DC-CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHIROPRACTIC FIRST
Mailing Address - Street 2:3195 S. BASCOM AVE
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-6728
Mailing Address - Country:US
Mailing Address - Phone:408-559-1662
Mailing Address - Fax:408-559-0946
Practice Address - Street 1:CHIROPRACTIC FIRST
Practice Address - Street 2:3195 S. BASCOM AVE
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6728
Practice Address - Country:US
Practice Address - Phone:408-559-1662
Practice Address - Fax:408-559-0946
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC33786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor