Provider Demographics
NPI:1184776361
Name:HUDYNCIA, TIMOTHY DEFOREST (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DEFOREST
Last Name:HUDYNCIA
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 1:2797 POST RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-3001
Mailing Address - Country:US
Mailing Address - Phone:401-732-4400
Mailing Address - Fax:401-732-4455
Practice Address - Street 1:2797 POST RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3001
Practice Address - Country:US
Practice Address - Phone:401-732-4400
Practice Address - Fax:401-732-4455
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor