Provider Demographics
NPI:1912279647
Name:CAMBRIDGE, TIMOTHY T (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:T
Last Name:CAMBRIDGE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:TANH
Other - Middle Name:HUU
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 611466
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95161-1466
Mailing Address - Country:US
Mailing Address - Phone:408-809-5638
Mailing Address - Fax:855-218-3370
Practice Address - Street 1:5410 SUNOL BLVD STE 4
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7654
Practice Address - Country:US
Practice Address - Phone:408-809-5638
Practice Address - Fax:855-218-3370
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11935111NX0100X
CA33351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0100XChiropractic ProvidersChiropractorOccupational Health