Provider Demographics
NPI:1720054653
Name:TIMMER, STEVEN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:TIMMER
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 1:935 W LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2104
Mailing Address - Country:US
Mailing Address - Phone:816-781-6556
Mailing Address - Fax:816-781-6847
Practice Address - Street 1:935 W LIBERTY DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2104
Practice Address - Country:US
Practice Address - Phone:816-781-6556
Practice Address - Fax:816-781-6847
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO30296021OtherBLUE CROSS BLUE SHIELD
MOL37B386Medicare ID - Type Unspecified
MOU87263Medicare UPIN