Provider Demographics
NPI:1295584522
Name:WINDSOR, TIMOTHY ALAN (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALAN
Last Name:WINDSOR
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 1:7000 MAE ANNE AVE APT 2424
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-7149
Mailing Address - Country:US
Mailing Address - Phone:775-997-8142
Mailing Address - Fax:
Practice Address - Street 1:1343 BARING BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8664
Practice Address - Country:US
Practice Address - Phone:779-391-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor