Provider Demographics
NPI:1740342302
Name:SHARPE, TIMOTHY ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:SHARPE
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 1:19676 BLUFFVIEW PL
Mailing Address - Street 2:
Mailing Address - City:GALESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54630-7272
Mailing Address - Country:US
Mailing Address - Phone:608-582-2498
Mailing Address - Fax:
Practice Address - Street 1:1111 LINDEN DR
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9527
Practice Address - Country:US
Practice Address - Phone:608-526-9693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2346111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38836500Medicaid
WI00070160Medicare ID - Type Unspecified
WIT86500Medicare UPIN