Provider Demographics
NPI:1033268479
Name:ROSE, TIMOTHY D (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:D
Last Name:ROSE
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:PO BOX 230427
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-0427
Mailing Address - Country:US
Mailing Address - Phone:334-264-7948
Mailing Address - Fax:334-264-8616
Practice Address - Street 1:2941 ZELDA RD STE B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2699
Practice Address - Country:US
Practice Address - Phone:334-264-7948
Practice Address - Fax:334-264-8616
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK375OtherMEDICARE GROUP NUMBER
ALP00271767OtherMC RAILROAD
AL510-01480OtherBCBS
AL510-01480OtherBCBS