Provider Demographics
NPI:1457895799
Name:TIMMERMAN, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:TIMMERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 JFK RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-3896
Mailing Address - Country:US
Mailing Address - Phone:563-556-0601
Mailing Address - Fax:563-556-0605
Practice Address - Street 1:1920 JFK RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-3896
Practice Address - Country:US
Practice Address - Phone:563-556-0601
Practice Address - Fax:563-556-0605
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor