Provider Demographics
NPI:1942281647
Name:HUBBARD, TIMOTHY DALE (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DALE
Last Name:HUBBARD
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 1:20055 SW PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9294
Mailing Address - Country:US
Mailing Address - Phone:503-625-2225
Mailing Address - Fax:503-925-8840
Practice Address - Street 1:20055 SW PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9294
Practice Address - Country:US
Practice Address - Phone:503-625-2225
Practice Address - Fax:503-925-8840
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR113765Medicare PIN
ORU02959Medicare UPIN