MEDICARE: DR. TIMOTHY RUSSELL SEXTON D.C.

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	06387	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24151	OTHER	IA	BCBS

General Provider Information

NPI Number	:	1235225947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY RUSSELL SEXTON D.C.

Provider Business Mailing Address
First Line	:	6221 SE 14TH ST
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50320-1708
Country	:	US
Telephone Number	:	515-988-3613
Fax Number	:	515-287-3044

Provider Business Practice Location Address
First Line	:	6221 SE 14TH ST
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50320-1708
Country	:	US
Telephone Number	:	515-287-3993
Fax Number	:	515-287-3044

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/10/2024

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