Provider Demographics
NPI:1740380369
Name:WAKEFIELD, TIMOTHY S (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:WAKEFIELD
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 1:500 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552-1415
Mailing Address - Country:US
Mailing Address - Phone:715-762-2950
Mailing Address - Fax:
Practice Address - Street 1:500 BIRCH ST
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552-1415
Practice Address - Country:US
Practice Address - Phone:715-762-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2521-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICI2400OtherRAILROAD MEDICARE GROUP
27443OtherSECURITY HEALTH PLAN
WI38987800OtherMEDICAID GROUP
WI350023255OtherRAILROAD MEDICARE
WI38847300Medicaid
WI38847300Medicaid
WI38847300Medicaid