Provider Demographics
NPI:1831332717
Name:TIMOTHY J CITRO DC PLLC
Entity type:Organization
Organization Name:TIMOTHY J CITRO DC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CITRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-294-6200
Mailing Address - Street 1:6445 S 12TH AVE
Mailing Address - Street 2:SUITE 151
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-7680
Mailing Address - Country:US
Mailing Address - Phone:520-294-6200
Mailing Address - Fax:520-294-6201
Practice Address - Street 1:6445 S 12TH AVE
Practice Address - Street 2:SUITE 151
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-7680
Practice Address - Country:US
Practice Address - Phone:520-294-6200
Practice Address - Fax:520-294-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty