MEDICARE: DR. TIMOTHY D RUNNELS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	9478	TX

General Provider Information

NPI Number	:	1053314336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY D RUNNELS DC

Provider Business Mailing Address
First Line	:	5643 TREASCHWIG RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-7162
Country	:	US
Telephone Number	:	281-443-1287
Fax Number	:	281-442-1288

Provider Business Practice Location Address
First Line	:	5643 TREASCHWIG RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-7162
Country	:	US
Telephone Number	:	281-443-1287
Fax Number	:	281-443-1288

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/17/2009

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