Provider Demographics
NPI:1265571921
Name:ESPOSITO, TIMOTHY J SR (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:ESPOSITO
Suffix:SR
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 1:2017 AVENIDA FELICIANO
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1008
Mailing Address - Country:US
Mailing Address - Phone:310-514-8356
Mailing Address - Fax:
Practice Address - Street 1:1848 LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1906
Practice Address - Country:US
Practice Address - Phone:310-326-2922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21676111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0216760OtherCHIROPRACTIC
CAU35238Medicare UPIN
CADC0216760OtherCHIROPRACTIC