Provider Demographics
NPI:1295933182
Name:GRUND, TIMOTHY LEE (DC, DACNB)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LEE
Last Name:GRUND
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 BROOKDALE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1538
Mailing Address - Country:US
Mailing Address - Phone:707-303-7177
Mailing Address - Fax:707-575-5579
Practice Address - Street 1:182 FARMERS LN STE 201
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4761
Practice Address - Country:US
Practice Address - Phone:707-575-5577
Practice Address - Fax:707-575-5579
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26728111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology