Provider Demographics
NPI:1770709461
Name:MENG, TIMOTHY EDWARD (D C)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EDWARD
Last Name:MENG
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 BLUE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64052-1351
Mailing Address - Country:US
Mailing Address - Phone:816-252-6886
Mailing Address - Fax:816-252-6898
Practice Address - Street 1:2701 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64052-1351
Practice Address - Country:US
Practice Address - Phone:816-252-6886
Practice Address - Fax:816-252-6898
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3272111N00000X
KS3258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0002852Medicare ID - Type UnspecifiedPRACTITIONER PART B#